RG 121 



■ 

II 

■ ■ 

III m 




BiQtfl.'ali 



a Hi 










; ° 







v» rt o 




*b «o* • ••. ^ '•• .<T °* ^* 






> -jr "^ "^^.V"* „«7 y £ • CIP^Y A*"*. 
.<v % '.£V .o* * *«W?* a,* % 








**> * O „ * 4$ 











°o 







* o « o * $r u w t 

V ♦ 1, * "' <?* 




A v .1... ^>. ? 



HEALTH NOTES 



FOR 



YOUNG WIVES 



AIMEE RAYMOND SCHEOEDER, M.D. 




J>/V0U 



NEW YORK 
WILLIAM WOOD & COMPANY 

1895 



Copyright 1895 

BY 

WILLIAM WOOD & COMPANY • 



PREFACE. 

There is no doubt that, even under the 
most favorable conditions, the months of 
pregnancy represent a time of physical 
and mental trial to the young mother. Be 
the anticipations of parenthood never so 
joyful, the child never so ardently longed 
for, the preparations for its advent made 
with a tender pleasure hitherto unknown, 
the mind filled with plans for its future 
care and education, mingled in the more 
serious -minded with feelings of almost 
awful responsibility in the ushering into 
life of a human soul, still there must of 
necessity be often present the thought of 
the coming ordeal, the time of danger and 
of pain. Moreover, physical disturbances 
of a more or less severe nature frequently 
accompany or complicate the condition. 
Some of these are in certain cases unavoid- 
able; others could be avoided by a little 



11 PREFACE. 

knowledge and care. A good physician 
should be the chief source of information, 
inasmuch as each case differs from an- 
other in many particulars, according to 
the peculiarities of the individual, so that 
it is difficult to lay down general rules to 
meet every emergency. Busy practition- 
ers do not always remember to give in- 
formation upon minor points, unless spe- 
cially consulted upon them; the timidity 
natural to most women, or a total igno- 
rance of the body and its laws and needs, 
causing them to accept all symptoms as a 
matter of course, prevent their asking the 
necessary questions, and thus oftentimes 
they suffer quite needlessly from the lack 
of a little simple instruction. Moreover, 
not all women are so situated that they 
can call upon their physician for help in 
every dilemma. To these young wives in 
especial it is hoped that the following 
pages may be of use. 

The author wishes to acknowledge her 
indebtedness for valuable facts to the 
works of Drs. Lusk, Parvin, Bulkley, 
Shoemaker, Winckel, Munde, Lloyd, Gar- 



PREFACE. iii 

rigues, Winckel, Penrose, Clara Shaw, 
and George Allan, D.D.S. 

The tables of infant feeding are quoted 
from Dr. T. M. Rotch, and the dietary for 
children after weaning from Dr. Samuel 
Adams. 



contents. 



CHAPTER I. 

PAGE 

Introductory Remarks — Structure of the Organs 
of Generation — Development of the Child . . 1 

CHAPTER II. 

Symptoms of Pregnancy — Prenatal Influences — 
Choice of Physician and Nurse 12 

CHAPTER III. 

Essentials of a Healthy Pregnancy — Hygiene of 
the House — Occupations — Exercise — Diet 
— Bathing — Sleep — Douches — Clothing — 
Care of Breasts 24 

CHAPTER IV. 

Nausea and Vomiting — Constipation — Diarrhoea 
—Excess of Saliva— Care of the Teeth 43 

CHAPTER V. 

Anaemia — Swelling of Lower Extremities — Vari- 
cose Veins— Piles — Palpitation — Fainting — 
ifficulty in Breathing 59 



VI CONTENTS. 

CHAPTER VI. 

PAGE 

Disorders of the Bladder and Kidneys— Con- 
vulsions— Itching of Vulva— Leucorrhoea— 
Vegetations 70 

CHAPTER VII. 

Disorders of the Nervous System — Mental Atti- 
tude of the Expectant Mother — Sleepless- 
ness — Neuralgia 82 

CHAPTER VIII. 

Diseases of the Skin— Mask of Pregnancy — 
Pruritus 93 

CHAPTER IX. 

Diseases which forbid Pregnancy — Effect of 
Pregnancy upon certain Diseases 97 

CHAPTER X. 
Miscarriage 107 

CHAPTER XI. 
Preparations for Confinement 115 

CHAPTER XII. 

The Stages of Labor — Directions for the conduct 
of Labor in Emergencies — After-care of 
Mother 131 



CONTENTS. Vll 

CHAPTER XIII. 

PAGE 

Care of the Infant after Birth — Bath — Dress- 
ing the Cord — Examination of Child — 
Attention to Bowels and Bladder — Sleep. . . 165 

CHAPTER XIV. 

Debility in the Newly-born — Apparent Asphyxi- 
ation — Care of the Eyes , . . . . 173 

CHAPTER XV. 

Infant Feeding — Weaning— Diet after Weaning 
—Bathing 184 

Index 203 



OHAPTEE I 

INTRODUCTORY REMARKS — STRUCTURE 

OF THE ORGANS OF GENERATION — 

DEVELOPMENT OF THE CHILD. 

It may not be the manifest destiny of 
every woman to become a wife and a 
mother. It is, however, a possibility to 
all. That being the case, it is a matter 
to astound the thoughtful that so little 
preparation for their probable experiences, 
needs, and duties is deemed necessary. 
Many readers will remember Mrs. Diaz's 
story of the philosopher from a distant 
planet who comes to this earth and whose 
notice is attracted to the little children. 
Upon inquiry he finds that they are the 
future men and women of the country; 
that dangers of all kinds surround them — 
inherent evil tendencies may readily de- 
velop into crimes threatening not only 
their own but the country's welfare ; dif- 
ferences of temperament call for the 



2 INTRODUCTORY. 

utmost skill, discernment, wisdom, and 
knowledge in their education, and it is 
granted that no occupation can excel this 
in its scope, power, and influence. Upon 
further inquiry he finds that the "opera- 
tors upon these delicate and complex pieces 
of mental machinery " are the mothers, 
and, with a delightful naivete, he takes it 
for granted that such all-important per- 
sonages in the nation as the mothers must 
be the recipients of an education most 
comprehensive and judicious, as well as 
one especially directed to the vocation 
which is conceded to be peculiarly theirs 
— an education which will teach them to 
understand the various temperaments of 
their children and their needs, to direct 
the culture of their intellectual and moral 
nature, and to apply hygienic laws in 
their physical training. When he dis- 
covers that although the training of chil- 
dren is universally held to be a woman's 
chief business, yet the young women re- 
ceive no special education fitting them 
for it, that husbands rarely think of pro- 
viding their wives with literature designed 



INTRODUCTORY. 3 

to give them the necessary information, 
the philosopher indulges in the following 
soliloquy: " There seems to be blindness 
and stupidity somewhere among these 
people. From what they say of the diffi- 
culty of bringing up their children, it 
must take an archangel to do it rightly; 
still they do not think a woman who is 
married and settles down to family life 
needs much education. Moreover, in edu- 
cating young women, that which is uni- 
versally acknowledged to be the chief 
business of their lives receives not the 
least attention " ! ! 

Leaving aside ethical considerations, and 
looking at the matter merely from the 
point of view of physical self-preserva- 
tion, is it not strange indeed that the body, 
the one thing which is ever present with 
us from birth until death, to which we 
are chained in a life sentence, as it were, 
and whose welfare concerns us more inti- 
mately than any other thing in the world, 
is precisely that which arouses the least 
interest ? All the "ologies" seem to take 
precedence over physiology; yet a study 



4 THE THORAX. 

more fascinating in itself and more per- 
sonally interesting could not easily be 
imagined. However, it is not our place 
to write a treatise on physiology. A few 
words upon the structure of the organs 
special to women may, however, be of use 
to the wife and expectant mother, and are 
necessary to the understanding of what 
happens in pregnancy. 

That portion of the body known as the 
trunk is divided into two parts, the thorax, 
or chest, and the abdomen. 

The thorax reaches from the neck to 
the lower extremity of the breast bone in 
front, and to the last rib on each side. 
It contains the lungs, heart, and great 
blood vessels. The abdomen is divided 
into the upper part, or abdomen proper, 
and the lower, or pelvis. The former ex- 
tends from the chest, from which it is 
separated by a muscular partition called 
the diaphragm, to a point a trifle below 
the upper border of the hip bone. It con- 
tains the stomach, the greater part of the 
bowels or intestines, the liver, spleen, pan- 
creas, and kidneys. Just below the abdo- 



ORGANS OF GENERATION. 



mq^L proper, and artificially divided from 
it to facilitate description, is the pelvis, or 
pelvic cavity, which contains a small part 
of the intestines, the bladder, and the or- 
gans of generation. In the centre is the 




Fig. 1. —Uterus and Appendages. 
a, 6, c, uterus; d, neck of uterus; /, /, ligaments holding up 
uterus; #, g, Fallopian tubes; h, fimbriated end of tube, 
opened to show its form ; », z, ovaries ; k, vagina, opened to 
show neck of uterus. 

uterus, or womb, which is, in those who 
have never borne children, a pear-shaped 
body, about two and a half inches long, 



6 ORGANS OF GENERATION. 

one and a half broad at the upper part, 
half an inch in the lower, and is one inch 
thick. It is composed of muscle, with 
a lining of mucous membrane, and is 
hollow. From each side of it projects a 
tube from three to four inches long, its 
cavity continuous with that of the uterus, 
but only one-twenty-fifth of an inch in 
diameter at the opening. The Fallopian 
tube, as it is called, increases in size to- 
ward the outer end, where it is large 
enough to admit a goose quill. It does 
not extend in a straight line, but curves 
slightly upward and then downward ; its 
ends are fringe-like in shape, and one of 
these fringe-like points is attached to an 
oval, solid mass, about an inch and a 
half long, known as the ovary. This is 
fastened, by means of a little cord or liga- 
ment about an inch long, to the uterus. 
These five bodies— uterus, tubes, and 
ovaries — constitute the organs of genera- 
tion. The lower part, or neck, of the ute- 
rus projects into a canal from two and a 
half to three inches long, called the va- 
gina. Although a canal, its walls lie 



THE OVARIES. 7 

close together. The external organs of 
generation are called collectively the vulva. 

The ovaries contain a large number of 
tiny egg cells or follicles ; there are about 
thirty-six thousand in each one. During 
childhood they are not perfectly developed, 
but at the age of puberty (which varies 
from about the tenth year in hot countries, 
such as India, to the eighteenth or twen- 
tieth in cold countries, such as Norway, 
and in our own country is at the thirteenth 
or fourteenth year) these cells mature, and 
about every fourth week one bursts open 
upon the surface of the ovary, discharging 
an ovum, or egg, which is about one- 
one-hundred-and twentieth of an inch in 
diameter. The ovum, in some way not 
yet perfectly understood, is carried into 
the Fallopian tube through the finger-like 
ends, and travels by way of the tube into 
the uterus, from which it is discharged 
into the vagina. A flow of blood usually 
accompanies its discharge, and is known 
as menstruation, or monthly sickness. 

The process described is that occurring 
to the unfertilized ovum. When, how- 



8 THE PLACENTA. 

ever, conception has taken place, a very- 
different series of events occur. Instead 
of being discharged through the vagina, 
the ovum fastens itself to the uterine wall. 
Both the ovum and the lining of the ute- 
rus undergo great changes : membranes 
are thrown around the little egg, until it 
is enclosed in a small bag ; the child de- 
velops within this pouch, which becomes 
filled with fluid and is known as the " bag 
of waters." Meanwhile, about the end of 
the third month of pregnancy, the pla- 
centa or after-birth is formed upon and 
from the lining of the uterus. It is a soft 
mass, consisting chiefly of blood vessels, 
which are separated from the blood vessels 
of the embryo, or foetus, or young child, 
by only a thin membrane, through which a 
constant interchange takes place of waste 
matters from the blood of the child, and 
nourishment from the blood of the mother. 
The infant, or, more properly speaking, 
the foetus, is connected with the placenta 
by means of the umbilicus, umbilical cord, 
or navel string. 

As the child increases in size the uterus 



DEVELOPMENT OF THE CHILD. 9 

also grows until it reaches to about an inch 
below the lower end of the breast bone. 
Of course it pushes upon the organs of 
the abdomen, displacing them more or less, 
so that it is not at all wonderful that many 
uncomfortable sensations are produced 
merely by the development of the child. 
At the end of the months of pregnancy 
"term" is reached, and "labor," which 
means contraction of the muscular walls 
of the uterus, expels the infant. The ute- 
rus then begins to diminish in size, and in 
a few weeks has returned almost to its 
original dimension, which is, however, 
never entirely regained. It may interest 
the young mother to know the stage of de- 
velopment of the child at different periods 
in the pregnancy. 

During the first month it has no defi- 
nite form, and is about one-twelfth of an 
inch in length. 

At the commencement of the second 
month it is about half an inch in length 
and weighs about sixty grains. The head 
may be just distinguished. Toward the 
end of the second month the body is from 



10 DEVELOPMENT OF THE CHILD. 

one to one and a half inches long. The 
head and extremities are visible. 

Third month.— The body grows to the 
length of three, or even three and a half, 
inches. Fingers and toes are formed. 
The head is large compared with the body. 
Nose, ears, anus (entrance to bowels), and 
mouth are formed — the two last-named 
being closed. Eyelids joined together ; a 
membrane covers the pupils. 

Fourth month.— Length of body, five 
and a half to six inches. Weight, three 
to six ounces. The sex is distinguishable. 
The mouth and anus are open. The nails 
begin to appear. 

Fifth month. — Body grows from five 
and a half to nine or ten inches by the 
end of the month. Weight increases to 
ten ounces. 'The head is one-third the 
length of the whole foetus. Hair and nails 
visible. Downy hair appears over the sur- 
face of the whole body. 

Sixth month. — Length, eleven to twelve 
inches. Weight, one pound. Hair and 
eyelashes distinct. The pupils are still 



DEVELOPMENT OF THE CHILD. 11 

covered by the little membrane, and the 
eyelids adhere together. 

Seventh month, — Length, about four- 
teen inches. Weight, three to four pounds. 
The eyelids open, and the membrane over 
the pupil begins to disappear. The nails are 
formed, and an oily matter covers the skin. 

Eighth month.— Length, about sixteen 
inches. Weight, four or five pounds. The 
membrane over the pupil disappears. The 
nails reach to the ends of the fingers. 
The downy hair begins to disappear from 
the face. 

Ninth month.— Length, eighteen to 
twenty inches. The weight varies, the 
average being about seven pounds. A 
few cases are on record of children weigh- 
ing fifteen and sixteen pounds, but they 
were usually still-born. 



CHAPTER IT. 

SYMPTOMS OF PREGNANCY — PRENATAL 

INFLUENCES— CHOICE OF PHYSICIAN 

AND NURSE. 

The young wife is frequently at a loss to 
determine whether she be really pregnant. 

The symptoms of pregnancy are di- 
vided into two classes: those in the first 
can be decided upon by the mother herself; 
those in the second, by the physician. Yet 
it must be remembered that no one sign is 
absolutely positive, and that a group of 
such symptoms must be present before it 
can be definitely announced that she is with 
child. 

Absence of the monthly sickness 
is the first thing usually noticed, and under 
ordinary conditions this is accepted as 
proof, especially if it have been absent for 
two successive periods. It must, however, 
be borne in mind that a low physical con- 
dition, poverty of the blood, cold, fatigue, 



SYMPTOMS OF PREGNANCY. 13 

and even fright or excitement of any kind, 
will, in some persons, cause a non-appear- 
ance of menstruation. In a few cases, on 
the other hand, the condition of pregnancy 
has not been suspected because the month- 
ly flow has continued to appear two or three 
times, or even, though rarely, throughout 
pregnancy. Frequently a white discharge 
occurs at the usual time for the flow, or 
even at other times; but it need cause no 
alarm, as it is merely a result of the con- 
gested state of the uterus. 

Morning sickness is a second sign. 
This is often entirely absent, and it may 
be caused in the non-pregnant by dyspep- 
sia; still, in connection with absence of the 
monthly sickness, it is a valuable indica- 
tion. It occurs after the first two or three 
weeks, is most marked in the second month, 
and usually ceases at the end of the third 
month. 

Changes in the breast constitute the 
third sign. A slight feeling of fulness, a 
little tingling sensation, or sensitiveness to 
pressure, or pain, is sometimes experi- 
enced. At any time from the end of the 



14 SYMPTOMS OF PREGNANCY. 

first month to the end of the fourth cer- 
tain changes in color occur: the skin of 
the nipple, which becomes more promi- 
nent, is darkened, and the pink ring 
around it becomes brown in hue. Slight 
grain-like elevations also appear on this 
ring. These changes are not an invari- 
able rule, and they are of value in deter- 
mining a first pregnancy only, as the 
coloration and granulation are usually 
permanent. 

An increase in the size of the abdo- 
men is the fourth sign, but as it may come 
from fat, from gas in the bowels, from 
tumors, or even from hysteria, it is not 
an absolute guide. During the first eight 
weeks, indeed, the abdomen becomes flat- 
ter, because the increased weight in the 
uterus tends to drag it downward. As the 
child develops, however, it rises higher and 
higher. At the end of the twelfth week 
it may be felt just above the bone in front, 
known as the pubic bone; at the end of the 
sixth month it is about on a level with the 
navel; and at the end of the thirty-eighth 
week it reaches to almost the end of the 



SYMPTOMS OF PREGNANCY. 15 

breast bone, sinking a little during the two 
weeks before labor. 

Quickening, known as "feeling life/* 
is the fifth sign, felt about the eighteenth 
or twentieth week. This is due to the 
movements of the child, and is at first a 
slight, tremulous feeling rather than a defi- 
nite motion, becoming more pronounced 
as the child increases in size and strength. 
The movements may be so few and so in- 
considerable as scarcely to be felt through- 
out pregnancy, or so active as to cause 
considerable pain. In some cases they 
suddenly cease altogether for weeks, or 
even for the remainder of pregnancy, 
causing the mother to fear that the child 
has died. Death of the foetus sometimes 
occurs, to be sure, but rarely, and mere 
cessation of the movements need not cause 
alarm. On the other hand, women of a 
nervous temperament, and those very de- 
sirous of having children, have sometimes 
mistaken muscular movements for quick- 
ening. As a rule, however, the symptom 
is readily recognized. 

By careful examination of the abdomen 



16 SYMPTOMS OF PREGNANCY. 

in the early months, and of the uterus 
through the vagina, the physician is able 
to perceive certain signs more indicative 
of pregnancy than are the sensations ex- 
perienced by the mother. A purple tint- 
ing of the parts, changes in the neck and 
body of the uterus, perception of various 
parts of the child's body, and, most impor- 
tant of all, the sound of the child's heart, 
are some of these signs. The latter is 
heard by pressing the ear to the abdomen. 
The foetal heart beats more rapidly than 
that of the mother, and is an infallible 
sign of pregnancy, but rarely perceptible 
before the eighteenth week. Sometimes 
two hearts are distinctly heard, and the 
physician is able to detect the presence of 
twins. 

The young mother is always anxious to 
know how to determine the exact date of 
her confinement. This is a very nearly 
impossible thing, as there exists a certain 
amount of irregularity, varying with indi- 
viduals, and as it is rarely possible to know 
the exact date of conception. One au- 
thority states that a child may be born 



SYMPTOMS OF PREGNANCY. 17 

within two hundred and forty to three 
hundred and twenty days of the last 
menstrual period. The average duration 
of pregnancy is two hundred and eighty 
days — forty weeks, or ten lunar months — 
and the usual method of calculation is to 
count backward three months from the 
date of the beginning of the last men- 
struation, and then add seven days (in 
leap years, after February, six days). No 
physician should be blamed for refusing 
to fix the exact date of confinement. 
Neither should he be expected to foretell 
the birth of twins, for this is oftentimes 
absolutely impossible of prediction. Pa- 
rents are usually anxious to know the 
sex of the child before birth, and some 
even hope to influence the production of 
the desired sex. Even physicians have 
attempted to solve the problem, books and 
articles have been written upon the sub- 
ject, various startling and original theo- 
ries have been announced. It may be 
definitely asserted, however, that as yet 
science has thrown no light upon the sub- 
ject, and parents must still be content to 



18 PRENATAL INFLUENCES. 

wait until the birth of the child decides the 
question. 

Another and more important subject 
often occupies the attention of the young 
mother. Can she, of her own will, in- 
fluence the health, character, tempera- 
ment, mind, and appearance of the child 
whom she is bearing ? Widely do the opin- 
ions of physicians vary upon this point. 
Some assert that certain sights, emotions, 
thoughts, and desires have a pronounced 
effect upon the unborn babe ; that de- 
formities or objects which have made a 
profound impression upon the mother are 
reproduced upon the child ; that by per- 
sistent gazing at pictures of beautiful 
persons the child may be endowed with 
similar beauty ; that scientific, literary, 
artistic, musical, or kindred tastes may be 
created by a firm determination on the 
part of the mother that they shall exist ; 
and, in fact, that within certain limits 
almost any trend may be given to the 
character of the offspring. Many are the 
anecdotes related by women to illustrate 
this point ; while they cannot all be re- 



PRENATAL INFLUENCES. 19 

ceived without the proverbial grain of 
salt, it will not do to dismiss them as 
altogether unworthy of attention. A suffi- 
ciently large number of well-authenticated 
facts following presumed causes are al- 
ways to be treated with respect, but one 
must be sure that they are authenticated, 
and that imagination, exaggeration, or 
mere hearsay does not play too large a role. 
Some men of science believe absolutely in 
this prenatal influence ; others of equal 
standing deny it altogether, and claim 
that the majority of the accounts are un- 
trustworthy, the remainder mere coinci- 
dences, and that nothing as yet known of 
physiological laws warrants the belief that 
the mother can by any volition influence 
the child, nor that any emotional impres- 
sion can in any way alter its development. 
If, however, it please the young mother to 
believe that she can mould her child's 
character in these months of waiting, 
there can be not the slightest objection to 
her so doing. Since there is a doubt upon 
the subject, by all means let the child 
have the benefit of the doubt. Let the 



20 CHOICE OF PHYSICIAN. 

mother fill her mind with lofty, beauti- 
ful, and pleasing thoughts, read the best 
books, study masterpieces of art, listen to 
the noblest music, associate chiefly with 
those of her friends whose hearts and 
minds are best and truest, think only lov- 
ingly, hopefully, and with the highest 
aspirations of and for the coming life for 
whose being and well-being she is respon- 
sible. By so doing her own nature will 
be uplifted and her character strength- 
ened, and she will be better fitted to in- 
fluence and guide the child after birth — 
and perhaps before. Her mind, more- 
over, will be more diverted from her own 
physical ailments, and, by the reaction of 
mind upon matter, her body will be in a 
better condition to bear the coming or- 
deal. 

The choice of a good physician should 
be early made. Then the case should be 
put in his hands, and, without displaying 
undue fussiness, he should be consulted 
about details. Prudery should not in- 
terfere with a thorough examination, if it 
is thought advisable. While in the ma- 



EXAMINATION OF URINE. 21 

jority of cases the child is in the most 
natural position for delivery, in others 
there is what is called a malposition or 
false presentation. If the physician know 
of this in time, he can often by gentle 
measures remedy the trouble and save 
great pain and even danger. He should 
also know the shape and size of the bony 
parts which make up the pelvis, as such 
knowledge will greatly influence the man- 
agement of labor. 

The existence of diseases which might 
be transmitted to the child, or which might 
in some way increase the difficulties of 
labor, is sometimes unknown to the mother, 
but may be discovered by the physician in 
time to be checked. 

The urine should be submitted for ex- 
amination by the physician as often as 
once a fortnight, beginning with the sixth 
month of pregnancy. This is an absolute 
necessity, as many cases of kidney disease 
have resulted disastrously simply from 
neglect of this precaution. Early recogni- 
tion of albumin in the urine will warn the 
physician to institute a course of treat- 



22 SELECTION OF NURSE. 

ment which will greatly lessen the chances 
of harm. 

Unless the young mother have in view 
some particular nurse whom she is anxious 
to have with her during her confinement, 
it is well to leave the choice to the physi- 
cian. A graduate of one of the good train- 
ing schools is to be preferred ; but, should 
the price be too high for the purse of the 
patient, an intelligent woman, who is will- 
ing to follow the doctor's directions impli- 
citly, and who is not so filled with a sense 
of her own importance that she permits 
herself to add variations of her own to the 
treatment prescribed, may often be all that 
is needed. Midwives are to be avoided. 
In some countries they are by law obliged 
to receive special training ; in this country 
they are not. Many of them are able to 
conduct normal cases with intelligence ; 
very few know anything whatsoever about 
even the simplest complications. 

The pregnant woman seems to be re- 
garded as legitimate prey for the outpour- 
ing of advice, harrowing experiences, and 
superstitions known as "granny tales, " 



SUPERSTITIONS. 23 

Some of the latter are so absurd that one 
wonders that any reasonable woman can 
be made to believe them. Others have a 
semblance of truth. 

It is a time-honored belief that a 
thwarted ' ' longing " upon the part of the 
woman for any special article of food will 
result in a birth-mark upon the child re- 
sembling in shape the coveted article. 
This idea is entirely without foundation, 
but it is easy to see how a succession of 
coincidences may have given rise to its 
conception. But what shall be said of the 
gravely uttered prediction that " the child 
would be born without a hair on its head, 
because the mother had never experienced 
heartburn during pregnancy " ? Such a 
remark seems almost too senseless to quote, 
but it is a fair example of the many silly 
tales which would be harmless were it not 
for the fact that they disturb and worry 
the pregnant woman at a time when her 
mind should be peculiarly free from even 
the slightest anxiety. 



CHAPTER III. 

ESSENTIALS OF A HEALTHY PREGNANCY 
—HYGIENE OF THE HOUSE— OCCUPA- 
TIONS — EXERCISE — DIET— BATH- 
ING— SLEEP — DOUCHES — 
CLOTHING— CARE 
OF BREASTS. 

Pregnancy, or the condition of being 
with child, is not, as many seem to regard 
it, a diseased state of the system, some- 
thing out of the ordinary, unnatural, ab- 
normal. It is, on the contrary, a natu- 
ral condition, for which Nature has made 
every provision, and statistics go far to 
prove that the health of women who have 
borne children is, on the whole, better 
than that of the sterile. The condition, 
in other words, is physiological. Modern, 
or, as we call it, civilized, life has done 
much to complicate matters. The nearer 
to Nature a people live the easier are preg- 
nancy and labor. As we cannot, however, 



HEALTHY PREGNANCY. 25 

and would not if we could, revert to the 
condition of savages, our concern must 
be to ascertain what, under existing cir- 
cumstances, are the best means to secure 
a comfortable pregnancy and natural de- 
livery. 

The first essential is good health on the 
part of the mother, which includes her 
perfect physical development, maturity, 
and a sound condition of the uterine 
organs. The pelvis should be of fair size, 
the muscles of the body in good tone, 
and the general health good. As regards 
maturity, it may be asserted that in the 
very young and late in life pregnancy is 
not so well borne as between the ages of 
twenty and thirty-five. This, of course, 
does not mean that it is disastrous to have 
them before or after that time, but simply 
that the best conditions for both mother 
and child are met with at a period when 
the parent is fully developed physically 
and mentally, and in the prime of her vigor. 
There is a general impression that a first 
labor occurring after thirty-five years is 
apt to be fatal. This is erroneous: labor 



26 HEALTHY PREGNANCY. 

is likely to be longer in a woman of ma- 
ture years, because the body is usually 
more firmly knit and less yielding, and 
the dangers of prolonged labor, such as 
exhaustion and a possible tendency to 
haemorrhage, may be increased; otherwise 
there is no more danger than in the case 
of younger women. The very young and 
the very mature are more apt to miscarry 
than those in the prime of child-bearing 
life. 

The effect of pregnancy upon uterine 
troubles will be touched upon in a later 
chapter. Suffice it to say that it is a mis- 
take to suppose that they are likely to be 
cured by the condition. While a strong 
constitution is the first requisite to a good 
pregnancy, and while good health cannot 
be created in a few months, but is rather 
the outcome of inheritance or of judicious 
care from infancy, much may be done to 
strengthen the system and to overcome 
actual ills. It is always essential to ob- 
serve hygienic precautions or the laws of 
health; it is imperative during pregnancy. 

The VENTILATION, DRAINAGE, and 



HYGIENE OF THE HOUSE. 27 

heating of the house should receive 
careful attention. The air should be kept 
fresh and pure, and should consequently 
be changed very frequently; but rooms 
must not be allowed to become so cold 
that the patient feels chilly while sitting 
in them. It is a mistake to suppose that 
women living in the country necessarily 
have more fresh air than those living in 
crowded cities. They have, to be sure, 
every chance of obtaining it, but how 
many improve the opportunity ? In cold 
weather how often are the windows of 
the living room opened and the air per- 
mitted to rush in ? Are they not kept 
closed while the stove rages, and the dif- 
ferent members of the family sit in the 
room hour after hour, constantly adding 
to the heaviness and impurity of the air ? 
Every few hours the windows should be 
opened for several minutes, and, as the in- 
coming air is rich in oxygen, it will heat 
more rapidly than foul air. At night the 
window should be opened at least two 
inches ; the smaller the room the more 
necessary is this measure. Night air is 



28 HYGIENE OF THE HOUSE. 

not always the noxious thing which many 
people consider it; certainly not half so 
harmful as the atmosphere of a room 
which has been breathed over and over 
again by the persons in it, coming out 
each time from the lungs laden with 
waste matters from the body. It is not a 
pleasant thought that we are inhaling 
particles of matter from the organism of 
other people, yet we constantly and with 
perfect equanimity do what we consider it 
so unpleasant to think about ! 

One cannot be too careful in regard to 
drains, cesspools, and plumbing. No foul 
gases should come near the pregnant wo- 
man, whose system is doubly sensitive to 
injurious influences. There should be no 
doubt upon the subject : careful investi- 
gation should be made and evils promptly 
remedied. The room in which the patient 
is to be confined should, if possible, be 
chosen with especial reference to its health- 
fulness and comfort. It should be sunny, 
large, easily heated, easily ventilated, free 
from many hangings and draperies, scru- 
pulously clean, removed from the neigh- 



EXERCISE. 29 

borhood of water closet or privy. Details 
as to its preparation will be given later. 
In summer, of course, a cool c and shaded 
room will be chosen. 

Exercise is of great importance to the 
pregnant woman. This does not mean 
that she is to rush restlessly about, unnec- 
essarily fatiguing herself with extraordi- 
nary exertions, but it does mean that she 
should in pleasant weather keep in the 
open air as much as possible, and walk 
as much as she can without feeling 
tired. Dancing, horseback riding, run- 
ning, jumping, lifting heavy weights, lift- 
ing the arms high, in fact all exercise of 
a violent or jerking nature, is to be 
avoided. Quiet, regular walks, drives in 
an easy carriage, rides in the horse cars 
(not the omnibus), may all be done with 
benefit. Women who do their own house- 
work, and who feel able to do it at this 
time, can continue their usual habits in 
that respect ; but it would be best for them 
to hire some one to attend to the washing, 
scrubbing, and heavy sweeping. True, 
many strong women do all this work up to 



30 EXERCISE. 

the last moment and seem none the werse 
for it ; but the exceptionally strong cannot 
be taken as a guide to the average Ameri- 
can woman. Moreover, the after -history 
of many of these same apparently ro- 
bust women who take no precautions be- 
fore labor, and who often leave their beds 
within two or three days after confine- 
ment, does not always bear out their boast 
that it " hurt them not a particle." When, 
a year or two later, they seek the dispen- 
sary clinics for treatment of "womb 
troubles," it seldom occurs to them that 
there is any connection between their pre- 
sent ills and previous imprudence. 

No general rule can be given for exer- 
cise. What will benefit one patient may 
injure another ; but a little common sense 
goes a great way, and the reasonable wo- 
man will walk daily, if she can do so with- 
out fatigue, in spite of friends who would 
keep her stretched out upon her lounge in 
a condition of semi-invalidism, and refuse 
to walk when tired, notwithstanding accu- 
sations of laziness. If everything is pro- 
gressing in a natural manner, let her 



SELF-CONTROL. 31 

pursue her usual every-day life, enjoy the 
society of her friends, read, play, paint, 
and do whatever gives her the most plea- 
sure and keeps her in a cheerful frame 
of mind, but avoiding ill-ventilated and 
crowded halls and parlors. At the periods 
of the month corresponding to menstrua- 
tion it would be well for her to keep 
somewhat quieter than usual, and should 
there at such times be any pain she must 
maintain a reclining posture. 

If the pregnant woman is of an at all 
excitable disposition, let her endeavor at 
this time to exercise special self-control ; 
for the nervous equilibrium is very easily 
disturbed, and hysterical habits can readily 
be formed which may persist and render 
her life intolerable to herself and to her 
friends. By hysterical is not meant 
simply fits of laughing and crying, but 
rather an excess of emotional feeling dis- 
played in various ways, as extreme sen- 
sitiveness, irritability, excitement, exalta- 
tion alternating with despondency — in 
fact, " emotional excitement out of pro- 
portion to any given cause " ; a distur- 



32 DIET. 

bance of the serenity which should char- 
acterize a well-poised nature such as 
should belong to one who is to be guide, 
teacher, and example to a human being. 
While all who surround a prospective 
mother should endeavor to keep her in a 
cheerful, happy, soothed, and calm condi- 
tion, she herself should be doubly watch- 
ful to see that this state of mind be depen- 
dent upon inward force of character rather 
than upon external surroundings. To 
this end she should avoid the indulgence 
and cultivation of nonsensical fads and 
fancies, and rid herself of the idea that 
because she is " in a family way " she may 
and must do anything that comes into her 
head to do, on the pretext that to be 
thwarted in her wishes injures the child. 
Neither must she go to the other extreme 
and become so morbidly conscientious as 
to consider that the reaction of physical 
ailments upon the nervous system is an 
evidence of depravity upon her part. In 
fact, let her, as far as possible, deliberately 
keep her mind away from herself. 
As to the question of diet, if appetite 



DIET. 33 

and digestion are good, let her eat as 
heartily as she feels inclined of wholesome, 
nutritious food, such as soup, meat, vege- 
tables, bread, cereals, fruit, fish, oysters, etc. 
It is not, however, at all necessary to eat 
more than the usual amount of food, under 
the supposition that she is " eating for 
two." Highly spiced or rich dishes, fried 
food, sweets, desserts, wines, are to be 
taken in moderation, on account of the 
predisposition to indigestion. Coffee and 
tea should be sparingly indulged in ; a 
fondness for milk is to be encouraged, for 
a better diet does not exist. It would 
even be desirable to try to cultivate a taste 
for it, or to overcome a repugnance. Many 
with whom it does not easily digest might 
be able to take it skimmed, or with a tea- 
spoonful of lime water to the glass, or 
mixed with Vichy or Apollinaris, or con- 
taining a pinch of salt. The addition of a 
tablespoonf ul of Horlick's Malted Milk ren- 
ders it palatable to some ; or of a beaten 
yolk of egg, or a teaspoonful of sherry, 
port, or Madeira. Should any particu- 
lar article of diet be known to disagree, 



34 BATHING. 

it must of course be avoided. The rule 
is childishly simple, but daily broken by 
thousands who are not children. Spe- 
cial diet for those suffering from constipa- 
tion will be considered later. 

Certain writers have advocated the ex- 
clusive use of fruit or of vegetables in 
order to secure painless labor for the 
mother. Even were the result insured by 
such a course, which we have no warrant 
for believing, no true-hearted woman 
would wish to secure relief from pain at 
the expense of her child's health. That 
this would be the case is evident, since 
the whole aim of the treatment is to lessen 
the development of the infant and make its 
bones soft and pliable — in other words, to 
underfeed it and to give it a predisposi- 
tion to rickets. 

Bathing. — Women accustomed to a 
daily sponge bath of cold water may con- 
tinue its use, being careful, however, not 
to become chilled. Warm baths once or 
twice a week may be taken in addition ; 
they should not be too hot, and should not 
last longer than fifteen minutes. It is of 



BATHING. 35 

extreme importance that the whole body be 
frequently washed. If the pores of the 
skin be clogged by dust or excretions, the 
free action of the perspiration will be in- 
terfered with, and, as water and other 
substances representing waste material 
from the system must be got rid of, 
double work will be thrown upon the kid- 
neys, which in pregnancy are easily over- 
taxed and weakened, to their perhaps 
lasting injury. 

Russian and Turkish baths offer too 
great contrasts of heat and cold, and too 
violent passive exercise, to be safe during 
pregnancy. Sea bathing is also too fa- 
tiguing to be endured by any but the 
exceptionally robust. 

The external genital organs should be 
washed at least twice a day with warm 
water and soap, to which may be added a 
little Cologne or toilet water if desired. 
The advice may be considered superfluous 
by many naturally -neat women, but it is 
necessary in view of the widespread super- 
stition which exists against the use of 
water during pregnancy, and even during 



36 INTERNAL DOUCHES. 

menstruation. Water does no harm ; on 
the contrary, it prevents much annoying 
irritation and is in every way of benefit. 
Cold water may be used, but most people 
prefer tepid or warm water. Should there 
exist any irritation of the parts, clear 
water, or water in which a little borax is 
dissolved, should be used, or else, after 
washing with soap, the parts should be 
rinsed with clear water. 

Internal douches of warm (not hot) 
water may be taken with advantage, pro- 
viding that certain precautions be ob- 
served. Very hot water, or water pro- 
jected in sudden shocks, or coming with 
great force against the neck of the uterus, 
would be liable to cause miscarriage ; 
therefore the form of syringe worked by 
squeezing a rubber bulb is to be avoided, 
as it sends the water in jets. The fountain 
syringe, either as a rubber bag or any re- 
ceptacle connected by a long tube with the 
nozzle, is the one to be preferred, as the 
water flows continuously. It must not be 
placed high above* the body, for the force 
of the flow increases with the height; 



INTERNAL DOUCHES. 37 

about three feet will be the suitable dis- 
tance. The nozzle, or "tip," may be of 
rubber or glass, but the holes in it must 
be on the side£ and not at the end. The 
douche is to be taken in a reclining posi- 
tion, either on one of the douche pans 
which can be bought at a good drug store 
or instrument-maker's in the cities, or ly- 
ing crosswise on the bed, the hips drawn 
to the edge and the feet resting upon two 
chairs. A rubber sheet or piece of oil- 
cloth is placed beneath the body, and rests 
in a receptacle upon the floor, in such a 
way that the returning water is conducted 
into it. By means of this position, and by 
hanging the douche bag at a slight eleva- 
tion only, the stream of water is gentle, 
and the neck of the uterus and the vagina 
are bathed in it rather than subjected to 
any sudden shock. The douche may be 
taken in a sitting posture, which is of 
course a less complicated proceeding, but 
the water returns so quickly that it is less 
efficacious. However, it is much better 
than no douche at all. A teaspoonful of 
borax may be added to each quart of 



38 CLOTHING. 

water (no douche should contain less than 
two quarts), or a teaspoonful of the anti- 
septic known as creolin. 

The bowels must move freely every day. 
More will be said upon the subject in the 
next chapter. 

Sleep is a necessity to the pregnant 
woman. Her nights should be undis- 
turbed, and frequent naps during the day 
will calm her nerves and give her refresh- 
ment. She should lie down often in the 
daytime, closing her eyes and relaxing 
her muscles, even if she cannot sleep. 

The clothing, from the very early 
months of pregnancy, should be thor- 
oughly loose and comfortable. Some wo- 
men refuse to give up their corsets ; in 
such cases they should buy the lightest 
corset possible, remove the steel, and let 
out the laces until they feel no pressure 
when breathing deeply. A far better plan 
is to buy one of the many waists made on 
purpose for pregnancy, and obtainable at 
any corset shop, dry-goods shop, or reform- 
underclothing establishment. The under- 
clothing is to be fastened to it by buttons 



CLOTHING. 39 

or tapes, so that their weight will be borne 
by the shoulders rather than by the hips 
and abdomen. It is not a good plan to 
leave off the stays and fasten the under- 
clothing as usual, without any substitute 
in the way of a waist ; the bands and 
strings cut into the flesh and create much 
discomfort. The breasts, moreover, which 
are increasing in size and weight, need 
support. A tolerably comfortable waist 
may be manufactured out of an old corset 
by removing the steel, sewing on shoul- 
der straps, and cutting off the corset all 
around (or, if preferred, simply in the front) 
just below the waist line, sewing buttons 
or tapes near the edge to support the under- 
clothing. The breasts are supported, the 
lines are shapely and trim, yet there is no 
pressure upon the abdomen. But the steel 
must be removed. 

Tight clothing interferes with the 
circulation, with breathing, and with the 
digestion, predisposing to faintness, dys- 
pepsia, constipation, palpitation, and short- 
ness of breath; moreover, the bowels are 
crowded down upon the uterus, which is 



40 CARE OF THE BREASTS. 

more than ordinarily liable to be pressed 
out of place, with very serious results to 
the patient. 

Garters should not be worn. They in- 
terfere with the circulation and predispose 
to varicose veins. Stocking supporters that 
fasten to the corset waist can be purchased 
everywhere, or can be manufactured from 
a piece of elastic ending in two pieces of 
strong tape that contain buttonholes. Per- 
sons living in the country can order them 
by mail, as various kinds, all alike in gene- 
ral principles, are largely advertised. 

The body should be covered with flannel 
or silk, which in winter must be thick and 
warm, in the summer may be gauze-like 
in quality. The main point is that every 
part of the body should at all times be 
thoroughly warm and comfortable. 

The care of the breasts is of great 
importance, since their neglect may lead 
to intense suffering when the child begins 
to nurse. Cracked nipples cause an agony 
of pain, and sometimes lead to the forma- 
tion of abscesses. 

The breasts begin at a very early date in 



CARE OF THE BREASTS. 41 

pregnancy to increase in size and to be- 
come tender. All pressure must be re- 
moved from them, and there must be ample 
room for growth. Cotton wadding and 
other heating materials must not be placed 
over them. Breast-forms of crinoline 
gauze, such as are sold in corset shops, 
might be used to advantage to keep off the 
pressure of the clothing without heating 
the breasts. A secretion of a small amount 
of milk is early formed, and is apt to ooze 
and dry upon the nipples, forming crusts 
underneath which the skin becomes very 
tender. This should be gently washed off 
every day with warm water and castile 
soap, and rinsed with pure water. There 
should be no rubbing, but gentle pressure 
with a soft sponge or a bit of absorbent 
cotton. After the washing a little cocoa 
butter may be applied, or olive oil, almond 
oil, or cocoanut oil if preferred. Some have 
advised hardening the nipples with alco- 
hol, brandy, benzoin, arnica, etc. ; but Na- 
ture has placed many fat glands about the 
nipple, indicating that it is to be kept soft 
and pliable, and it would seem the most 



42 CARE OF THE BREASTS. 

reasonable plan to assist Nature, not by 
removing the oil, but by adding more. Oil 
gently rubbed on the whole breast every 
evening will do much to relieve the feeling 
of tightness and discomfort which comes 
from its swollen condition. 

Should the nipples be on a level with the 
skin or below it, they must be drawn out, 
so that when the child attempts to nurse 
it may be able to do so. Hard rubbing is 
injurious. They may be drawn out two 
or three times every day with the thumb 
and forefinger; or the bowl of a clean clay 
pipe may be placed over them, and suction 
made through the stem by another person. 
By means of a rubber tube fitted to the 
stem, the patient herself could perform this 
little manoeuvre, which should be kept up 
for about five minutes at a time. Breast 
pumps are sold for the purpose of develop- 
ing the nipple, but create so much suction 
that, unless used just in the right way, 
they are apt to do harm. 



OHAPTEE IY. 

NAUSEA AND VOMITING — CONSTIPATION— 
DIARRHCEA — EXCESS OF SALIVA- 
CARE OF THE TEETH. 

Nausea and vomiting are apt to oc- 
cur in pregnancy, and, when not excessive, 
need cause no alarm. They are, however, 
the source of so much discomfort and suf- 
fering that all possible means should be 
taken for their relief. " Morning sick- 
ness " has been so named because it usu- 
ally appears as soon as the patient raises 
her head from the pillow; it may, how- 
ever, come on at any time during the day. 
Sometimes there is intense nausea and 
very little vomiting ; in other cases there 
is no nausea, but food will simply not re- 
main in the stomach. These symptoms 
appear in the first few weeks of preg- 
nancy, and usually disappear within two 
or three months, but they have been 
known in rare cases to continue through- 



44 NAUSEA AND VOMITING. 

out the whole period of pregnancy. In 
any case it is better to consult the physi- 
cian; but when the condition, in spite of 
all efforts to overcome it, persists, and the 
patient loses strength and grows daily 
more feeble, a physician must be con- 
sulted. 

It would be beyond the province of 
this book to prescribe for this condition 
of "pernicious vomiting/' which, untreat- 
ed, may become a most serious compli- 
cation. For the relief of the more or- 
dinary form of the trouble there are 
several methods to be tried. In the first 
place, let the patient be given a cup of 
weak tea or of coffee, with or without a 
dry biscuit or a piece of toast, the first 
thing in the morning, before she has even 
attempted to rise. Let her then lie down 
for a quarter of an hour, a half-hour, or 
an hour if necessary, rise slowly and 
dress quietly, sitting down as much as 
possible and avoiding all sudden move- 
ments. If the breakfast is rejected, and 
the patient has sufficient courage, let her 
repeat it three or four times if necessary, 



NAUSEA AND VOMITING. 45 

for sometimes by such persistence the 
food is finally retained. 

Vomiting occurring just before or just 
after a meal can often be overcome by a 
strict attention to diet, by refusing every- 
thing which is difficult of digestion, and by 
experimenting with a variety of food sub- 
stances in order to determine what will be 
tolerated by the stomach. Sometimes a 
little cracked ice taken just before a meal 
will relieve the trouble, or a mustard plas- 
ter or hot-water bag or bottle applied to 
the skin over the stomach may answer the 
purpose. If regular meals are out of the 
question, it is well to try the effect of giv- 
ing a little food very often — about every 
two hours. Soups, chicken broth, clam 
juice, extract of beef in boiling water, to 
which is added a little rice or vermicelli, 
the white of an egg in ice-water or shaken 
up in sherry, a cup of hot milk, equal 
parts of milk and lime water, or milk and 
Vichy or Apollinaris, or soda water, kou- 
myss, dry champagne, toasted Boston 
crackers, soda crackers, any dry biscuit 
or cracker which is not sweet, are some of 



46 HEARTBURN — CONSTIPATION. 

the articles of food which may be tried. 
It is essential not to repeat the same thing 
too often, otherwise disgust may be ex- 
cited, and only a small amount should be 
given at each time. Nibbling a dry bis- 
cuit will often give comfort when nothing 
else is retained by the stomach. Should 
the patient express a decided wish for any 
particular article of food, unless it is 
known to be indigestible it would be 
well to try it, not because thwarting the 
" longing" would injure the child, but 
because the capricious stomach of the 
mother may be able to retain the coveted 
article and give the condition of the diges- 
tive organs a turn for the better. 

It should be understood that in some 
cases the nausea and vomiting absolutely 
cannot be overcome, and the mother must 
simply wait and bear it as patiently as she 
can. 

Heartburn often occasions much dis- 
tress, but can rarely be entirely cured. A 
half-teaspoonf ul of the aromatic spirits of 
ammonia in water may give relief. 

Constipation is one of the most fre- 



CONSTIPATION. 47 

quent disorders of pregnancy, and, while 
sometimes the result of a constipated 
habit, often occurs in those who at other 
times are perfectly regular. It is of the 
utmost importance that it should be over- 
come ; the waste material from the child 
as well as from the mother has to be 
thrown off during pregnancy ; moreover, 
neglect in this particular leads to nausea 
and vomiting, loss of appetite, headaches, 
pains in the back and abdomen, and haem- 
orrhoids or piles. In the last months of 
pregnancy the presence of thick masses in 
the intestines may assist in causing pre- 
mature labor. Straining efforts are also 
very harmful. 

The patient should make an effort every 
day at the same hour to obtain an evacua- 
tion of the bowels. No matter whether it 
is successful or unsuccessful, it should be 
persisted in daily, and no attempt be made 
at any other hour than the one chosen. A 
habit may thus be established. Very little 
seems to be known by the majority of 
people about the laws governing the action 
of the intestines. It is not a simple pro- 



48 CONSTIPATION. 

cess, but one influenced by several agents. 
The intestines are partially composed of 
muscle, which, like all muscles, are con- 
trolled by the action of the nerves. A 
slow, continuous movement of these mus- 
cles narrows the tube and pushes its con- 
tents gradually onward through the twen- 
ty-five feet of its length until it reaches 
the rectum, whence it is expelled. This 
motion, or peristalsis, as it is called, is in- 
creased by some influences, diminished by 
others. The presence of a fair-sized mass 
of waste matter excites its activity, where- 
fore it is easy to infer that a diet proper to 
a regular action of the intestines must be 
composed not only of nourishing food, but 
of ^ood which contains considerable mate- 
rial not needed in the system, which will 
act mechanically upon the walls of the 
bowels. The condition of the nervous 
system is also important, a fact which few 
people realize, and which may account for 
some of the apparently miraculous cures of 
constipation effected by methods of treat- 
ment which, by placing the patient's mind 
in a condition of passive acquiescence, 



CONSTIPATION. 49 

faith, or enthusiasm, as the case may be, 
bring the nerves into obedience to this 
mental state, and often do good work in 
relieving symptoms of diseases which are 
directly under the control of the nervous 
system. This influence is generally rec- 
ognized in hysteria. But an ignorance 
of physiology prevents a great number of 
people from realizing that many forms of 
constipation belong to the class of nervous 
disorders. If they were not fonder of fol- 
lowing vagaries than of listening to their 
own physicians, they might give science 
the credit for what they prefer to ascribe 
to " science falsely so-called." A proof of 
the action of the nerves upon the intes- 
tinal tract is seen in the action of violent 
emotions — grief, anxiet}^, suspense, worry 
— in causing constipation or diarrhoea, an 
experience common to every one. 

Again, the flow of bile has a marked 
effect upon peristalsis, and foods adapted 
to stimulate its flow will sometimes have 
to be taken. Glands in the small intestines 
secrete fluid which aids in the healthy 
action of the bowels. In diarrhoea these 



50 CONSTIPATION. 

glands are so active that they afterward 
are obliged to rest from their activity, 
which accounts for the constipation that 
usually follows looseness of the bowels. 
Some medicines act directly upon these 
glands and give watery stools, resulting 
later in costiveness. 

Exercise, by increasing the circulation 
of the blood and by giving tone to the 
muscles and also to the nerves, is a great 
weapon in the warfare against this dis- 
order. 

It will be seen, by this very imperfect 
outline of the forces controlling the ac- 
tion of the bowels, that the remedies lie 
close at hand. Diet is of the first impor- 
tance, but here, as usual, individual pe- 
culiarities come into play, and what will" 
benefit one will not affect another. 

Sweets, such as cakes, candies, and pies, 
are constipating and should be avoided. 
Meat and bread are very nutritious foods, 
but do not contain enough waste material ; 
to them should be added green vegetables, 
oatmeal and other cereals, brown bread, 
figs, stewed prunes, honey, and baked 



CONSTIPATION. 51 

apples. Fruit acts like a charm upon 
some, while in other cases it causes indi- 
gestion with resulting constipation. An 
apple, orange, or grape fruit before break- 
fast has cured certain cases of costiveness. 
Coffee and tea are as a rule constipating, 
but some people depend upon their morn- 
ing cup of cafe au-lait to bring about the 
desired action of the bowels. Oftentimes 
drinking a large amount of water at dif- 
ferent times during the day will be of use ; 
some people take a glass of cold or of hot 
water upon arising, and another at night 
just before retiring. Vichy or Apollinaris 
may be preferred. Should diet prove of 
no value in overcoming constipation, it is 
very likely that the nervous system is at 
fault. The directions given in a previous 
chapter should be followed, and a quiet, 
calm, healthy condition of the nerves cul- 
tivated. The formation of the habit of 
daily solicitation of the action of the 
bowels, with concentration of the mind 
upon the process, will probably act upon 
the nervous system in time. Sometimes 
the waste material daily accumulates in 



52 CONSTIPATION. 

the rectum, but the patient has not ner- 
vous force sufficient to expel it, or else the 
mass of matter is so dry that it passes' 
with difficulty. In these cases the inser- 
tion in the rectum at night of a piece of 
cocoa butter, as large as the first joint of 
the little finger, will often be efficacious ; 
or injections may have to be resorted to, 
which may consist of two or three tea- 
spoonfuls of olive oil in a little water, 
of about a pint of hot water in which is 
dissolved a teaspoonful of salt, or the 
same amount of soap and water. These 
dissolve the hardened masses. A small 
amount of cold water acts upon the mus- 
cles of the rectum, and is perhaps the best 
form of injection to take, as it strength- 
ens instead of enfeebling the parts. A 
large amount of water should never be 
used in an enema ; it distends the rectum 
so enormously that the muscles are weak- 
ened by the stretching and after a while 
refuse to act. 

Should the trouble lie further up in the 
intestine and be unaffected by diet, exer- 
cise, and injections, laxatives will have to 



DIARRHCEA. 53 

be administered. Strong purgatives must 
not be used in pregnancy, and very few 
laxatives should be taken without consult- 
ing the physician. Castor oil is too apt to 
be followed by constipation to be useful; 
Hunyadi water, magnesia, and seidlitz 
powders are of benefit where the bowels 
are to be cleared out with rapidity on some 
one occasion; but they should not be de- 
pended upon in habitual constipation, as 
they act upon the glands that secrete fluid 
and lead to their inactivity later. Licorice 
powder is a good laxative. Rhubarb is 
sometimes apt to cause griping. The pre- 
parations of cascara sagrada are the best 
to take, in spite of their unpleasant taste, 
as they act by strengthening the muscles 
of the intestines instead ' of weakening 
them. A teaspoonful of the fluid extract 
of cascara taken at night will usually be 
sufficient to produce a natural movement; 
more obstinate cases may take a second 
teaspoonful in the morning. 

Diarrhcea, the opposite condition, is 
often a troublesome complication of preg- 
nancy. It may be simply the result of 



54 SALIVA. 

undigested food which is detained in the 
bowels and causes irritation. The offending 
matter should be removed by means of a 
wineglassful of Hunyadi water, or a seid- 
litz powder; should this not cause a cessa- 
tion of the difficulty, the doctor must be 
consulted. An injection of warm water 
will often be of benefit, and in any case 
will often relieve the burning sensation at 
the lower part of the rectum caused by 
acrid discharges. Only the simplest food 
should be eaten, avoiding green vegetables, 
fruit, and other opening articles of diet. 

Saliva in increased amount is often 
an annoying accompaniment of pregnancy. 
It is not dangerous unless it become so 
marked as to affect the appetite and diges- 
tion, and so to weaken the system. It is 
not possible to entirely cure this symptom, 
but relief has sometimes been obtained by 
chewing gum arabic, sugar candy, small 
pieces of dried orange peel, holding pieces 
of ice in the mouth, or rinsing the mouth 
with a few drops of the tincture of myrrh 
in a teaspoonful of water. Preparations 
of iron taken as a tonic give some relief. 



INFLAMMATION OF THE GUMS. 55 

Inflammation of the gums may oc- 
cur. It is sometimes confined to slight 
redness and swelling; in other cases the 
trouble is far more serious, the gums bleed 
profusely, are extremely tender, and shrink 
away from the teeth, which become loose 
in their sockets. A good dentist should 
be at once consulted. One, well known 
for his researches in the line of dental 
medicine, says: "During pregnancy the 
teeth should be well cared for, and on lines 
abreast with the knowledge of the day as 
to the causes of decay and loss of the teeth. 
The old saying that ' each child costs a 
tooth * has a grain of truth in it, but un- 
fortunately the underlying facts in the 
case are generally misapprehended. The 
customary belief is that the substance of 
the teeth of the expectant mother is ab- 
sorbed, and in some mysterious manner 
transposed to the organs of the developing 
child; in other words, that the child's teeth 
are nourished directly at the expense of the 
mother's. This is all a mistake. There is 
no such thing as a direct or indirect trans- 
ference of substances from the teeth of 



56 CARE OF THE TEETH. 

the mother to the child. The teeth of the 
pregnant woman and the nursing mother 
do suffer during these periods, but wholly 
from other and more simple reasons. In 
fact, the woman's condition is only to be 
held accountable to the same extent as, 
and no more than, any other invalid 
state that would bring in its train bodily 
weakness, mental and moral distress, ac- 
companied by disturbed digestive func- 
tions. Such a condition causes neglect of 
the ordinary care and attention that the 
teeth usually receive. Teeth once formed 
and in their place become diseased and 
troublesome from external influences only. 
This fact should be constantly kept in 
mind. The decay of the teeth always 
starts on the outside, and is brought about 
by the formation of an acid or acids from 
the decomposition of particles of food in 
the crevices of or between the teeth. The 
direct agents at work are bacteria. It 
may safely be stated as a rule that if the 
mouth and teeth are kept clean and sweet, 
the teeth will suffer no more at this period 
than at any other in a woman's life." 



CARE OF THE TEETH. 57 

Scarcely any one at the present day 
needs to be told that bacteria are micro- 
scopically small vegetable growths, of 
many forms and diverse natures, some 
harmless, others the cause of a variety of 
diseases. They develop rapidly wherever 
suitable ground is found, and this, for 
some species, consists in dirt or decom- 
posing animal or vegetable matter, accom- 
panied by moisture and warmth. Un- 
cleansed teeth most admirably fulfil these 
conditions. It follows that cleanliness is 
their foe. The teeth must be brushed 
with a good tooth powder at least twice 
a day, having a care to twist and turn 
the brush in such a way that the bristles 
will enter the spaces between the teeth. 
An up-and-down motion is better than 
a sideways movement, and the patient 
need not be afraid of plying the brush 
vigorously, even when the gums are ten- 
der. At night the teeth should be scoured 
with castile soap, or with the Melior tooth 
soap sold for the purpose, in order to coun- 
teract acid secretions from food. The 
mouth should also be rinsed daily with an 



58 CARE OF THE TEETH. 

antiseptic — a few drops of Listerine in a 
spoonful of water, or the Dental Elixir of 
Dr. Edward Kirk, which is a delightful 
preparation. Salt and water is a good 
substitute for those unable to afford the 
luxury of the above-mentioned antiseptics. 
If the patient is unable to attend to her 
teeth, an attendant or nurse should do so. 
Toothpicks and floss silk should be used to 
dislodge particles of food, and about once 
a week the tartar may be removed from 
the teeth by taking a little stick of wood 
(cedar if obtainable), thinned at the end, 
and dipping it into a good tooth powder, 
such as the Melior for instance, thoroughly 
scraping the teeth outside, inside, and be- 
tween, especially near the gums. 

There is no need of offering up teeth 
upon the altar of Maternity. 



CHAPTEK V. 

ANEMIA — SWELLING OF LOWER EX- 
TREMITIES—VARICOSE VEINS — PILES 
— PALPITATION — FAINTING — DIF- 
FICULTY IN BREATHING. 

The circulation of the blood during 
pregnancy is more active than at other 
times, the pulse being increased in fre- 
quency and in fulness. The amount of 
water in the blood is increased, the red 
blood globules decreased ; there is less al- 
bumen and less iron than usual. This is 
not a diseased condition, but if at all ex- 
aggerated may easily become so, and even 
when not exaggerated is apt to cause cer- 
tain unpleasant symptoms, such as dizzi- 
ness, ringing in the ears, dimness of sight, 
flushing of the face, etc. 

Anjemia, or poverty of the blood, shown 
by pallor of the face, of the gums, and of 
the mucous membrane under the eyelids, 
causes general weakness, loss of appetite, 



60 SWELLING OF FEET AND LEGS. 

pains of a neuralgic nature, dizziness, 
fainting, disturbances of digestion. The 
patient should be more than usually care- 
ful to follow the laws of health ; to live in 
the light and air and sunshine ; to walk 
daily as far as her strength will permit; to 
eat simple and nourishing food ; to keep 
the bowels open, secure uninterrupted sleep 
at night, and to rest frequently during the 
day; to keep the mind as cheerful as possi- 
ble by congenial society, harmless amuse- 
ments, and the reading of entertaining 
books. Should medicine be needed, and 
the physician not obtainable, one of Blaud's 
five-grain iron pills may be taken three 
times a day after meals. 

Swelling of the feet and legs, 
and even of the vulva, often becomes 
troublesome, especially toward the last 
months of pregnancy. When this is not 
due to a diseased state of the kidneys (a 
fact which the physician ascertains by ex- 
amination of the urine), this symptom need 
not cause alarm unless the swelling be ex- 
treme. The treatment for mild cases con- 
sists in lying down or keeping the feet 



VARICOSE VEINS. 61 

elevated as often as possible, and in apply- 
ing hot wet cloths when the swollen part 
becomes painful from distention. Reme- 
dies to increase the flow of urine and thus 
remove fluids from the body will be given, 
if necessary, by the physician, and tonics 
administered. 

Varicose veins, or dilated veins, some- 
times cause discomfort and pain, but are 
less apt to occur in a first pregnancy than 
when a mother has already borne several 
children. Women who stand much upon 
their feet are more subject to them than 
others. In the legs they cause a feeling 
of heaviness, fatigue in walking, and a 
dull ache which disappears in the horizon- 
tal position. When the trouble is seated 
in the deep veins and severe in its nature, 
the legs become feeble and trembling, al- 
most unable to support the weight of the 
body. Rupture of these large veins is 
rare, and when it occurs is usually due to 
a fall, a blow, or to scratching. Should 
this accident occur, the leg must be ele- 
vated and a finger pressed firmly upon 
the bleeding point until medical aid can 



62 VARICOSE VEINS. 

be summoned. This is very important ; 
the loss of blood, if excessive, may cause 
fainting, or even death. 

For the relief of the discomfort caused 
by varicose veins the patient should, as 




Fig. 2. 

in the case of swollen extremities, lie 
down as much and as often as possible, or 
keep the feet elevated. Although mode- 
rate exercise is beneficial, let her avoid 
long walks, standing, or fatiguing efforts. 



VARICOSE VEINS. 63 

Garters greatly aggravate the trouble, as 
do tight corsets and bands about the waist. 
Abdominal belts, if well made and well 
fitting, afford relief by removing pres- 
sure on the veins. They may be obtained 
of a reliable instrument-maker in any city. 




Fig. 3. 

Cloths wrung out in hot water, wrapped 
about the leg and frequently renewed, 
often give relief, and a properly applied 
bandage is of the utmost benefit. A piece 
of soft unbleached muslin is cut into strips 
two and a half inches wide and sewed to- 
gether at the ends. Beginning at the foot, 



64 VARICOSE VEINS. 

several turns are made around it to give a 
strong support ; then the bandage is wound 
firmly around the ankle and up the leg, 
letting each twist overlap the other about 
an inch. When the calf is reached and 
the bandage begins to bulge, it should be 
reversed by sharply folding it over upon 
itself, and then continued around as be- 
fore. A little practice will soon make this 
easy. If this description is not under- 
stood, a stitch may be taken wherever the 
bandage bulges, to make it lie smoothly. 
It should be firm enough to give support, 
but should not press uncomfortably at any 
point nor give a general sensation of 
tightness. It should be removed at night. 
Some prefer a rubber bandage. Elastic 
stockings of silk or thread can be ordered 
at a reliable drug store or of instrument- 
makers. It is always best to have them 
made to order and fitted to the leg, but 
they can, if necessary, be ordered through 
the mail, carefully following directions for 
measurement which are furnished upon 
application. 
Varicose veins of the genital region 



HEMORRHOIDS. 65 

often cause intense itching, but must not 
be scratched for fear of rupture. The 
patient should lie down a great part of the 
time, and, if there be a sensation of heavi- 
ness and stretching of the skin, she can 
apply a pad of cotton batting, wrapped in a 
linen napkin which keeps it in place. Hot 
wet cloths may be applied to give relief. 

Hemorrhoids, or Piles, are really 
varicose veins about the rectum, and may 
be internal or external. They are often 
caused by constipation, which allows of 
an accumulation in the rectum of hard 
matter which presses upon the blood ves- 
sels, interferes with the circulation of the 
blood, and consequently causes a dilata- 
tion of the blood vessels. Straining at 
stool further increases the pressure and 
the difficulty. They may also be caused 
by the pressure of the enlarged uterus 
upon the blood vessels. Sometimes the 
trouble is so slight as to cause very little 
inconvenience, merely giving a sensation 
of discomfort when sitting or standing, 
and disappearing within a few days. In 
other cases the pain is intense and the dis- 



66 HEMORRHOIDS. 

comfort almost unbearable ; the patient 
can neither sit, stand, nor walk without 
pain ; the piles, if external, swell and be- 
come tense and hard, tender and painful 
to the touch ; if internal they may bleed 
or swell, and protrude from the opening, 
giving a sensation of weight impossible to 
describe, and a constant desire to empty 
the bowels. Hard matters passing these 
tumors irritate and wound them, some- 
times leaving a raw and ulcerated surface. 
The pain at stool is agonizing, and a burn- 
ing sensation often persists during a great 
part of the day. 

When the haemorrhoids are very severe 
the physician must be consulted. 

Constipation must be overcome, and 
a free movement of the bowels obtained 
every twenty-four hours. Powdered sul- 
phur, compound licorice powder, mag- 
nesia, a wineglassful of Hunyadi water, 
will give soft stools. An injection of 
warm water in which are a few teaspoon- 
f uls of sweet oil may produce the neces- 
sary action. The diet should be simple 
and consist largely of green vegetables 



PALPITATION OF THE HEART. 67 

and fruit. Alcohol is to be avoided, and 
tea and coffee very sparingly taken. If 
the piles protrude from the rectum they 
must be pushed back in place, using a 
small sponge or a soft rag wet with cold 
water. 

For relief of the pain, injections of a 
small quantity of cold water (half a pint) 
are sometimes of benefit. Small bits of 
cocoa butter or lard introduced into the 
rectum have a soothing effect upon inter- 
nal piles. Hot wet cloths, upon which 
has been sprinkled a little laudanum, may 
be laid on the parts when the pain is ex- 
treme, but frequent local baths of cold 
water, and injections of cold water in suf- 
ficiently small quantity to be retained, are 
better as treatment of the condition. 

Many women are troubled with palpi- 
tation of the heart. This may be 
due to anaemia, to nervousness, to indiges- 
tion, or to pressure of the enlarged uterus 
upon the blood vessels, interfering with 
the circulation and thus with the action 
of the heart. It may come on after eat- 
ing, or at night, or be caused by violent 



68 FAINTING ATTACKS. 

emotion. The best treatment is quiet, rest, 
and strict attention to diet, which should 
be nourishing and non-stimulating. If it 
come on when the patient lies down, let 
her be propped up with pillows and sleep 
in that position. Ten drops of the spirits 
of camphor or half a teaspoonful of the 
compound tincture of lavender in a table- 
spoonful of water sometimes calm the 
nerves. Very severe and frequently re- 
peated palpitations must be treated by the 
doctor. 

Fainting attacks sometimes occur 
and need not occasion alarm. They may 
follow a sudden change of position, be 
caused by excitement or emotion, or come 
on during a meal or while digestion is 
going on. The loss of consciousness may 
be complete or may be only partial. The 
woman should be laid flat on the floor or 
couch, without a pillow under her head, 
her clothes loosened, and plenty of fresh 
air should be admitted. Smelling salts 
may be applied to the nose, ten drops of 
the spirits of camphor in a tablespoonf ul of 
water may be put in the mouth, or half a 



DIFFICULTY IN BREATHING. 69 

teaspoonful of the aromatic spirits of am- 
monia in the same amount of water. If 
that do not restore her to consciousness 
the hands and feet may be rubbed, and 
mustard leaves applied to the soles of the 
feet. A person subject to attacks of faint- 
ness must avoid crowded assemblies or 
overheated rooms, eat plentifully of sim- 
ple, nourishing food, secure free move- 
ments of the bowels every day, and live 
in the fresh air as much as possible. 

Difficulty in breathing is frequent- 
ly experienced during the latter months of 
pregnancy, and while it may be due to the 
fact that the enlarged uterus presses the 
other organs against the diaphragm, and 
this upon the lungs, it is often purely a 
nervous symptom, and is frequently ac- 
companied by a nervous cough. Very 
little can be done in the way of relief, 
except to see that the clothing is loose 
and to assume whatever bodily position 
is found to give the most ease. 



OHAPTEE VI. 

DISORDERS OF THE BLADDER AND KID- 
NEYS — CONVULSIONS— ITCHING OF 
VULVA — LEUCORRHCEA — 
VEGETATIONS. 

The bladder being situated directly in 
front of the lower part of the uterus, it is 
easy to understand that as the latter or- 
gan enlarges it may by pressure cause a 
variety of disturbances in the former. 
There is often a desire to void the urine, 
occurring so frequently as to be a source 
of great annoyance to the patient. The 
amount of urine is not increased, but the 
pressure of the uterus upon the neck of 
the bladder causes an irritation which is 
manifested by straining movements that 
occur as often as every hour and result in 
the discharge of only a few drops of fluid. 
At a later stage there may be incontinence 
of urine — that is to say, an inability to 
retain it — coughing, sneezing, laughing, 



DISORDERS OF THE BLADDER. 71 

walking, or a sudden movement causing a 
small amount to be quite involuntarily 
expelled. These disorders are difficult to 
cure ; often the only remedy is the birth 
of the child, and that must be awaited 
with what patience can be commanded. 
Some relief may be obtained by lying 
down with a pillow or two under the body 
to lift the pelvis and thus relieve pressure. 
The vulva must be washed frequently and 
thoroughly with hot water, as the urine 
has an irritating effect upon the skin, and 
talc powder or a good toilet powder may 
be dusted over the surface. 

The opposite condition of difficulty in 
passing water, amounting sometimes to 
absolute retention of urine, may be 
caused by direct pressure of the enlarged 
uterus, may depend upon nervous influ- 
ence, or may in the later months be due to 
the position of the .child's head as it sinks 
into the pelvis. It will not do to let this 
condition remain without treatment. If 
urine has not been passed for twelve hours, 
active measures must be taken. The pa- 
tient may try the effect of immersion in a 



72 DISORDERS OF THE KIDNEYS. 

very hot full bath or in a sitz bath for ten 
or fifteen minutes. Should this not suc- 
ceed, the doctor or nurse must introduce 
the catheter and relieve the bladder; this is 
a very simple matter, giving no pain what 
ever. Retention of urine, if neglected, 
may lead to inflammation of the bladder, 
to distention, and even to rupture. 

Allusion has already been made to the 
necessity for having the urine examined by 
the physician. As early as the sixth month 
specimens should be sent, in a perfectly 
clean bottle, as often as once a fortnight ; 
in the last two months it should be sent 
every week. The importance of doing this 
cannot be overrated. Before collecting 
the urine the patient should take a vagi- 
nal douche and wash the vulva, otherwise 
discharges from the vagina are apt to 
complicate the examination. 

The kidneys are especially liable to be- 
come diseased during pregnancy, and, if 
the condition is recognized in time, much 
may be done to improve it. Some of the 
symptoms are : swelling of the ankles and 
legs, hands and arms and face, with a puffy 



DISORDERS OF THE KIDNEYS. 73 

look beneath the eyes and a dry skin; 
headaches, dizziness, ringing in the ears, 
dimness of sight, neuralgias, constipation 
alternating with diarrhoea, nausea and 
vomiting of an obstinate type. A patient 
who has some of these symptoms should 
not therefore jump to the conclusion that 
her kidneys are diseased ; as we have seen, 
swelling may come from a poor condition 
of the blood or too little of it, and disturb 
ances of the circulation, while disorders of 
the digestive tract, pain, etc., may be due 
to various causes. She should, however, 
be put sufficiently upon her guard to take 
proper precautions, and to consult her 
physician, who will indicate a course of 
treatment. She can co-operate with him 
by, in the first place, avoiding any chilling 
of the body. It is well known that the 
kidneys and the skin, as well as the lungs 
and bowels, do their part in ridding the 
body of substances which it does not need. 
The amount of what is called insensible 
perspiration (that which passes off into the 
air as vapor and is not condensed in drops 
upon the surface of the body) is about two 



74 DISORDERS OF THE KIDNEYS. 

pounds daily. Any one who has worn a 
rubber cloak for several hours at a time 
must often have had occasion to notice 
this perspiration condensed upon its inner 
surface because it cannot pass through it. 
Now, in cold weather, and under the in- 
fluence of sudden chilling of the body, the 
blood vessels of the skin contract and less 
moisture is given off, which naturally 
throws more work upon the kidneys. 
Congestion of the blood also occurs in 
the internal organs under the influence of 
cold, in which the kidneys share ; if they 
are already weakened by disease it can 
readily be understood that any extra effort 
on their part will tend to further injure 
them. The chief thing, then, is to keep 
the skin in a healthy condition, in order 
that it may do its own share, and even 
a little more than its share, in ridding 
the body of waste matters. Warm daily 
baths, with vigorous rubbing of the skin as 
soon as the patient leaves the bath ; mas- 
sage to stimulate the circulation and by 
that means increase the perspiration; exer- 
cise for the same purpose; warm flannels 



DISORDERS OF THE KIDNEYS. 75 

all over the body to keep it warm and by 
their slightly irritating action to keep the 
skin in good condition; daily friction of the 
body with a brush or a coarse towel, are 
some of the means to be employed. A 
prolonged stay in hot water should not be 
resorted to, unless the physician advises it. 
Diet is of great importance in impending 
disease of the kidneys. In severe cases 
nothing but milk should be taken. If the 
patient object to milk it can be rendered 
more digestible by mixing it with Vichy. 
Apollinaris, or a little lime water ; and 
more palatable by heating, by the addition 
of a tablespoonful of coffee or even a tea- 
spoonful of rum, brandy, or whiskey. 
Rinsing the mouth with Listerine and 
water, peppermint water, or a few drops 
of the tincture of myrrh in water, will do 
much to relieve the unpleasant pasty feel- 
ing which some persons experience after 
drinking milk. Rennet pudding and other 
predigested milks make an agreeable 
change, as do matzoon and koumyss. 

Alcohol, except in medicinal quantity, is 
to be avoided in kidney disease, tea and 



76 DISORDERS OF THE KIDNEYS. 

coffee sparingly used, sweets and pastries 
to be entirely renounced, as little meat as 
possible to be eaten, the main reliance 
being placed upon milk and vegetables. 
Vichy water, Granular Lithia, Buffalo 
Lithia, Poland water, and seltzer may be 
taken in large amounts. 

Convulsions as a result of kidney dis- 
ease are fortunately of rare occurrence ; 
yet -it is desirable to know the symptoms 
of their approach, since, if they are immi- 
nent, medical aid should be at once sum- 
moned. They are usually ushered in by 
restlessness and uneasiness, headache, 
dizziness, nausea and vomiting, flashes of 
light before the eyes, seeing things double, 
dimness or loss of sight, and twitchings of 
the muscles, especially those of the face. 
The twitchings increase in violence and 
are united to convulsive movements of the 
arms and lower extremities. 

The patient should be laid upon a "bed 
or lounge and her clothing loosened. An 
abundance of fresh air should be admitted 
to the room. Part of a folded towel, nap- 
kin, or handkerchief placed between the 



ITCHING OF GENITALS. 77 

teeth will prevent biting of the tongue. 
The feet are to be kept warm, and no 
stimulants are to be administered. 

One of the most annoying of the minor 
ills of pregnancy is itching of the geni- 
tal kegion, which at times becomes abso- 
lutely intolerable. It may be due to irritat- 
ing urine, to a discharge from the vagina, 
to eczema, or it may be of purely nervous 
origin. Should simple measures fail to 
relieve it, the patient should not hesitate 
to have the parts examined, so that the 
cause of the trouble may be ascertained 
and treatment addressed to that cause. 

The following are some of the methods 
which may be employed to alleviate the 
discomfort : washing the parts several 
times a day in water as hot as can be 
borne, carefully drying with a soft cloth; 
sitting in lukewarm salt and water for a 
few seconds ; placing upon the parts a 
compress of linen or fine cotton soaked in 
borax water, in lead water, or in oil of 
sweet almonds, retained in position by a 
napkin. One authority recommends wash- 
ing the parts with warm water and drying 



78 ITCHING OF GENITALS. 

them with linen, then saturating a small 
sponge in a lotion composed of 

Bichloride of mercury grains 31 

Alcohol fluidrachms 3 

Rose water fluidounces 1| 

Distilled water fluidounces 15 

and passing it rapidly over the itching- 
surface, so as to thoroughly moisten it. 
The first sensation is that of burning, but 
this may be relieved by washing with cold 
water, and subsequent applications become 
less and less painful. The bottle contain- 
ing the lotion should be marked: " Poison. 
For external use only." 

Another writer recommends the follow- 
ing ointment: 

Camphor drachm 1 

Chloral hydrate drachm 1 

Ointment of rose water. ounce 1 

The two first-mentioned substances are to 
be rubbed up together, and the ointment of 
rose water added. 

The following lotion applied three times 
a day, after washing with water as hot as 
can be borne, is highly recommended: 



ITCHING OF GENITALS. 79 

Carbolic acid , drachm 1 

Chloral hydrate grains 40 

Spirits of camphor. drachms 2 

Glycerin drachms 4 

Water sufficient to make ounces 4 

When eczema is the cause of the irrita- 
tion, lead lotion (which can be obtained at 
any druggist's) or the lead and opium wash 
may be applied, the parts dried, and then 
powdered lycopodium, talc powder, or any 
good toilet powder dusted on the surface. 
The rjarts should always be washed imme- 
diately after passing urine, and must never 
be scratched or irritated. Perfect clean- 
liness, rest in the recumbent position, and 
an unstimulating diet will often be suffi- 
cient to relieve the distress. The avoid- 
ance of coffee alone will sometimes cure 
the trouble; tea and wine are to be es- 
chewed; milk, cocoa, and the mineral 
waters may be substituted. Soups and 
broths, beef, mutton, poultry, vegetables, 
bread and butter, eggs, oatmeal, hominy, 
and other cereals, fruit in moderate amount, 
may be taken ; but fried articles of food, 
pork, ham, and bacon, veal, salt fish, pas- 



80 LEUCORRHOEA. 

try, sweets, rich cake and puddings, must 
be avoided. Fresh fish and shell fish cause 
an irritating eruption in some cases; if 
there be no idiosyncrasy of this kind they 
may be eaten. 

Leucorrhcea, a white or yellowish- 
green discharge from the vagina, is not 
infrequent in pregnancy. This alone is 
often the cause of the burning and itching 
just described. Vaginal douches may be 
taken for its relief, bearing in mind the 
precautions recommended in a previous 
chapter. To each quart of water used 
should be added a tablespoonful of pow- 
dered borax, or a teaspoonful of powdered 
alum, or one of zinc sulphate or of carbolic 
acid. The douche should be taken morn- 
ing and evening, and the vulva washed 
several times during the day. 

Small wart-like growths sometimes 
appear at the entrance of the vagina, pink- 
ish in hue, and accompanied by pain, itch- 
ing, and a disagreeable odor. They need 
not cause alarm, for they are not danger- 
ous, but it will be very difficult to get rid 
of them. They may be bathed two or 



WART-LIKE GROWTHS. 81 

three times a day with tannic acid and 
water, using enough of the tannin to make 
a syrupy mixture, after which the parts 
should be kept separated by means of ab- 
sorbent cotton or pieces of linen. Should 
these vegetations grow with great rapidity 
and become very troublesome, a physician 
must be consulted. 



OHAPTEB TIL 

DISORDERS OF THE NERVOUS SYSTEM- 
MENTAL ATTITUDE OF THE EXPECT- 
ANT MOTHER— SLEEPLESSNESS- 
NEURALGIA 

To those who have studied the delicate 
adjustment of the nervous system, and 
who know how its thousands of tiny 
branches extend to every portion of the 
human frame and how intimately these 
branches are connected with each other, 
it is matter for small wonder that so great 
a change as pregnancy should cause sym- 
pathetic disturbances in remote parts of 
the body, and even affect the mental at- 
titude of the patient. As one writer well 
expresses it : " Pregnancy tries the en- 
durance and pose, as it were, of the mind 
— its capacity to face privation, discom- 
fort, danger, and, in the case of the 
primiparous woman " (one who is bearing 
her first child), "unknown and exag- 






DISORDERS OF THE NERVOUS SYSTEM. 83 

gerated horrors. In no walk of life 
where great cares of business or of state 
have at least their compensation, in no 
scene of action or danger where applause 
and heroism have their stimulation and 
reward, can there be found a more dismal 
and alarming conflict than that which in 
her imagination presents itself to the 
youthful, delicate, and untried woman 
when, alone and to a great extent un- 
aided, she first faces the inevitable hour. 
With the rumors and traditions which her 
curiosity has gathered in since first she 
learned the secret of generation, she en- 
dures the anxious suspense of many 
weary months of waiting, while during 
this period she often suffers much phy- 
sical discomfort and sometimes serious 
nutritional change. That this should 
affect her imagination, depress her spirits 
to the verge of melancholy, and even 
sometimes jeopardize her reason, will not 
be wondered at, I think, by those who 
engage extensively in obstetric practice." 
Loving relatives and friends are often 
grieved by the apparent change in the 



84- mother's mental attitude. 

disposition of the young wife ; irritability, 
morbid views of life, attacks of the 
"blues," fretfulness, an unreasonable 
state of mind, obstinacy, fads and fancies 
.for eccentric and unusual habits and 
ways and for strange articles of diet, ap- 
pear in persons who have hitherto been of 
a uniformly cheerful and evenly balanced 
temperament. These symptoms need not 
cause alarm ; without undue humoring, 
they can be largely checked by gentleness 
and patience, and they often disappear 
during the course of pregnancy, and, at 
latest, after the birth of the child. Let 
the young mother herself, as we have al- 
ready suggested, summon all her powers 
of will and intelligence to combat these 
tendencies to unnatural and unamiable 
frames of mind, and she may in great 
measure avert the danger of fixing upon 
herself habits which may last a lifetime. 
Let her cultivate hopefulness, remember- 
ing that each one of the 1,400,000,000 
inhabitants of the globe has been born 
in the same way. Let her realize that 
the marvellous advances of modern sci- 



mother's mental attitude. 85 

ence have done wonders in lessening the 
dangers of childbirth ; that the greater 
knowledge of possible complications en- 
ables the physician to remedy many causes 
of danger in pregnancy or early in labor ; 
that by careful examination of the urine 
another class of dangers may be averted ; 
that the skilled use of instruments not 
only shortens difficult labors, but permits 
of births which in the old days could not 
have occurred at all, but would have re- 
sulted in the death of child or mother, 
or both ; that the introduction of chlo- 
roform and ether has gone far to lessen 
the pain of labor ; and that the use of 
" antiseptics " has well-nigh abolished the 
much- dreaded childbed fever. Let her 
fix her mind upon the compensations, the 
joys of maternity, her proud position as a 
link in the chain of the past and the fu- 
ture. If she have not very strong mater- 
nal instincts, she need not be overmuch 
troubled by their absence, since they will 
usually be created by her child's need 
for her care ; but let her foster them by 
cultivating the acquaintance of sweet 



86 SLEEPLESSNESS. 

and well-bred children, and by the reading 
of well- chosen books bearing upon the 
subject. 

Let her prepare for motherhood as she 
would for a degree in letters, arts, or sci- 
ence, and she will find that her mental and 
moral disturbances will be greatly benefited 
thereby. 

Certain nervous disorders of a physical 
nature often cause great distress. We re- 
fer to insomnia, and to neuralgia in its 
various forms. 

Sleeplessness may become very dis- 
tressing toward the latter months of preg- 
nancy, and should be combated, as the 
pregnant woman requires more rather than 
less sleep than other women, and should 
endeavor to have surplus strength to meet 
the demands of labor. Let her in the 
early months form the habit of going to 
bed at a regular and early hour; let her 
avoid excitement of any kind in the eve- 
ning, and endeavor to have the mind in as 
tranquil a condition as possible upon retir- 
ing. If she finds that eating a late dinner 
interferes with her sleep, let her take a 



SLEEPLESSNESS. 87 

light meal in the evening. Coffee, tea, 
and wine are to be avoided. On the other 
hand, it may be of use to take a glass of 
hot milk, a bit of toast, a biscuit, or some 
other easily digested article just before 
going to bed. A warm bath in the evening 
will frequentl} 7 " induce sleep. The room 
should be well aired before she attempts 
to sleep, and well ventilated during the 
night; upon lying down the patient should 
try to relax both mind and body. We are 
aware that it is far easier to give this ad- 
vice than to follow it; nevertheless some- 
thing may be accomplished by persistent 
effort in the line indicated. The French 
are very fond of sipping sugared water in 
which are a few drops of orange -flower 
water, and claim that it conduces to sleep. 
It is harmless. If the sleeplessness cannot 
be overcome, the physician may be con- 
sulted in reference to some quieting medi- 
cine; but without professional advice the 
patient should on no account resort to 
drugs, no matter how highly recommended 
by a friend nor howsoever lauded by ad- 
vertisements. A dependence upon drugs 



88 TOOTHACHE. 

may be thus initiated, and lead to the 
formation of a habit which will wreck the 
future well-being and happiness of the pa- 
tient and all who care for her. It is im- 
possible to be too emphatic upon this point. 
Toothache, or dental neuralgia, often 
occurs during the first half of pregnancy. 
A dentist should be consulted to ascertain 
whether the teeth are in sound condition; 
if not, he will treat them appropriately. 
It is extremely foolish to have a tooth 
extracted simply because it aches; modern 
dentistry endeavors to preserve the teeth, 
even when they are diseased. If a dentist 
is not easily accessible, and the pain be 
known to be caused by a decayed tooth, 
various means may be tried for its allevia- 
tion. A hot- water bag may be pressed to 
the cheek, or a bag of hot hops or hot salt; 
a piece of cotton soaked in paregoric and 
laid on the gum against the aching tooth, 
or soaked in camphor and used the same 
way (the camphor will probably blister 
the gum, but, if the toothache be severe, 
the patient will scarcely mind that) ; or a 
bit of cotton soaked in the oil of cloves, 



NEURALGIA. 89 

which may also be pushed gently into 
any cavity which may exist in the tooth. 
Sometimes relief is obtained by laying on 
a bit of cotton soaked in ether, or by equal 
parts of oil of cloves and chloroform used in 
the same way, or chloroform in which ten 
grains of alum (to the half- ounce of chlo- 
roform) have been dissolved. It is also 
claimed that cotton steeped in chloroform 
and placed in the ear of the affected side 
will often give relief when other remedies 
have failed. 

^ Dry alcoholic ext. opium, 

Camphor aa grains 7£ 

Balsam Peru, 

Mastic, grains 15 

Chloroform aa drachms 2£ 

introduced into the cavity is said to stop 
the pain instantly. 

The pain of neuralgia often closely 
resembles that of toothache from a de- 
cayed tooth, owing to the fact that the 
nerves which go to the teeth are themselves 
affected and that the pain is conveyed 
along their course. It is not always pos- 
sible to relieve the pain, which, however, 



90 NEURALGIA. 

often disappears of itself. Good effects 
are frequently observed from clearing out 
the bowels by a dose of castor oil, cascara, 
Hunyadr water, or some other laxative. 
This may be followed by a tonic treat- 
ment — cod-liver oil or Blaud's iron pills, 
for example. Neuralgia of the teeth and 
face is sometimes relieved by rubbing the 
cheek or part affected with a mixture of 
equal parts of camphor and chloral hy- 
drate with double the amount of vaseline. 
A menthol pencil rubbed gently over the 
seat of pain has been known to help the 
condition. Or the following liniment may 
be used: 

Tincture of aconite root drachms 2 

Tincture of belladonna drachms 2 

Chloroform drachms 4 

Soap liniment ounce 1 

The suffering woman should avoid 
draughts and keep herself quite warm, 
applying hot flannels, hops, or a hot- 
water bag to the face, if relief be obtained 
thereby. In the way of internal medica- 
tion very little can be done, although some 
patients have derived benefit from the use 



PAIN IN LOWER PART OF BACK. 91 

of fifteen grains of the salicylate of soda 
taken three times a day in water, after 
meals. It is unfortunate that very few 
remedies can be said to be efficacious, since 
scarcely anything causes more suffering 
to the patient than neuralgia. 

Pains in the abdomen due to neural- 
gia are frequently observed during the 
later months of pregnancy. The treat- 
ment is the same as for the facial neural- 
gia. Very small blisters may be applied 
over the most painful spots — as, for in- 
stance, a piece of mustard leaf the size of 
a silver quarter of a dollar. 

Pain in the lower part of the back, 
in the pelvis, and cramps in the thighs and 
legs caused by pressure of the enlarged 
uterus upon the nerves which supply the 
lower extremities, often disturb the patient 
during the later months. The cramps 
come on at night as a usual thing, waking 
the patient from sleep. Rapid friction 
and deep kneading of the muscles of the 
leg are the best remedies, or walking 
briskly around the room, or quickly ex- 
tending and then bending the leg several 



92 PAIN IN LOWER PART OF BACK 

times in succession. For the relief of the 
pelvic pains and those of the back there is 
very little to be done; nevertheless it is 
worth while to try the effect of a support- 
ing bandage for the abdomen, especially 
if the latter be very large and have a ten- 
dency to become pendulous. The band- 
age may be made of a piece of thick un- 
bleached muslin, about a foot wide, shaped 
to the abdomen in front and snugly laced 
or pinned in the back. Or an abdominal 
supporter can be purchased of the instru- 
ment-maker. It is also of benefit to as- 
sume for ten or fifteen minutes at a time, 
night and morning, the knee-chest posi- 
tion. The patient kneels on the bed and 
rests her chest on a low pillow or on the 
?bed itself. This is efficacious by removing 
pressure for the time being. 



OHAPTEE Till. 

DISEASES OF THE SKIN — MASK OF 
PREGNANCY— PRURITUS. 

The skin is sometimes affected m vari- 
ous ways under the influence of preg- 
nancy, one of the most curious and annoy- 
ing modifications being the appearance of 
yellowish spots on the face, known as the 
mask of pregnancy. That the light has 
something to do with their causation is 
shown by the fact that they never extend 
beyond the roots of the hair, and that when 
the hair is worn over the forehead the part 
covered by it is free from the spots. They 
do not itch, and they are not raised above 
the surface of the skin. As they usually 
disappear after confinement, it is not nec- 
essary to treat them, the more especially as 
treatment is, as a rule, absolutely unpro- 
ductive of result. 

On the other hand, some chronic cases 
of skin disorders are completely cured or 



94: PRURITUS. 

greatly modified by pregnancy and by lac- 
tation. 

Pruritus, or itching, of the whole 
surface of the body is oftentimes a verita- 
ble torment to the pregnant woman, in a 
few rare cases even leading to miscarriage. 
A strict diet should be observed, such as 
was recommended in pruritus of the geni- 
tal region; the bowels must be kept freely 
open. Alkaline baths may be taken : five 
ounces of the carbonate of potash, or six 
ounces of borax or of cooking soda, or six 
ounces of powdered alum to a bathtub full 
of water, may be used. The woman may 
remain immersed in it for a few minutes, 
and after drying rub into the skin a lotion 
composed of three or four tablespoonf uls 
of the following prescription in a glass of 
warm water: 

Carbolic acid drachms 1 J 

Glycerin ounce I 

Water ounces 3 

Essence of thyme in sufficient quantity to 

impart an agreeable odor; this may be 

omitted. 

Cloths soaked in very hot water and 



PRURITUS. 95 

applied to the body sometimes afford relief. 
Menthol has been of use in some cases, in 
the proportion of ten grains to the ounce 
of vaseline or of sweet oil. A dusting 
powder which will occasionally give com- 
fort is composed of 

Powdered camphor drachm 1 

Bismuth subnitrate ounce 1 

Starch ounce 1 

Olive oil, cocoa butter, almond oil, or 
cocoanut oil may be rubbed into the skin, 
and bismuth or the a^bove-mentioned pow- 
der dusted over the body after their use. 
A good way to apply the powder is to put 
it into a little bag of fine cheese cloth, or 
several thicknesses of the coarser cheese 
cloth, and with this bag gently beat the 
surface of the body. An eminent physi- 
cian recommends this ointment : 

Naphthol grains 20 

Extract of belladonna grains 30 

Lard ounce 1 

or a half -ounce each of borax and pow- 
dered alum in a quart of hot water. The 
patient must persist in trying the various 



96 PRURITUS. 

remedies suggested, and not be too easily 
discouraged; yet it might easily happen 
that none of them would be efficacious. 
If her medical attendant cannot help her 
with internal remedies, then she must en- 
dure as best she can and await the cure 
effected by delivery. 



CHAPTER IX. 

DISEASES WHICH FORBID PREGNANCY 

— EFFECT OF PREGNANCY UPON 

CERTAIN DISEASES. 

The diseases which we have already 
considered have been those which are 
liable to occur during the course of preg- 
nancy, some of them, indeed, caused by 
the condition, and none of them apt to 
lead to disastrous results unless specially 
and very unusually severe in type. 

As regards other diseases, not the usual 
accompaniments of her condition, but to 
which she may be exposed during the 
months of expectancy, it is essential that 
the pregnant woman should know her 
liability to contract them, their influence 
upon her and upon the child, and the in- 
fluence of her condition upon the progress 
of the disease. She should also know 
what diseases should absolutely forbid her 

7 



98 NERVOUS DISORDERS. 

having children at all, although such 
knowledge were best obtained before the 
condition occurs than after. 

There is a widespread notion that dis- 
eases of the uterus are benefited by mar- 
riage and pregnancy. This is far from 
being the case. A healthy state of every 
organ in the body constitutes the ideal 
condition for the mother as regards her 
own health and that of the child. It is 
true that displacements are usually recti- 
fied during the months of gestation, but 
they often cause miscarriage or grave 
complications during labor. Moreover, 
with very few exceptions, the displace- 
ment again occurs, and usually in ag- 
gravated measure, after confinement. 

Nervous disorders and hysteria are 
popularly supposed to be cured by preg- 
nancy, but this, again, is an error. A 
cure has followed in some cases, due per- 
haps as much to the substitution of an 
absorbing interest for a morbidly self- 
centred condition, and the arousing of the 
higher and nobler faculties and emotions, 
as to any physical influence. The usual 



CONSUMPTION — EPILEPSY — BRIGHT'S. 99 

tendency would be toward the aggrava- 
tion of such disorders. 

The diseases which should absolutely 
forbid pregnancy are consumption, in- 
sanity, epilepsy, Bright's disease, cancer, 
certain diseases of the uterus, and de- 
formities of the pelvis. 

Consumption, in spite of an old theory 
that its course was delayed by the condi- 
tion, is, on the contrary, usually hastened 
in its progress. The child is, as a general 
thing, sickly and scrofulous, or it may be 
apparently healthy and develop consump- 
tion later in life. 

Insanity is very liable to be inherited. 
It is itself sometimes, but not always, un- 
favorably affected by pregnancy. 

Epilepsy is so likely to be inherited 
that it is recognized in law as cause for 
divorce, if it can be proved that its exist- 
ence in one- of the parties to a marriage 
was unknown to the other before the cere- 
mony. It is itself not much affected by 
pregnancy. 

Bright's disease is so disastrously 
influenced by the condition that, when 



100 CANCER— HEART DISEASE. 

marked, physicians usually consider them- 
selves justified in bringing on a miscar- 
riage, or, at least, a premature labor. It 
is not, however, believed to be hereditary, 
the risk being entirely to the mother. 

Cancer of the uterus is hastened in 
its development by pregnancy : the same 
is the case with certain other tumors of 
that organ, w r hich are so stimulated to a 
rapid growth that they not only endanger 
the life and health of the mother by their 
development, but may prove an obstacle 
to the birth of the child. 

Marked deformities of the pelvis 
may endanger the life of either mother or 
child; lesser deformities may simply com- 
plicate labor. It should be left to the 
physician to decide which is the case. 

Some forms of heart disease should 
come under the head of diseases forbidding 
the bearing of children, because they are 
aggravated by the condition of pregnancy. 
In any case they can only have a bad in- 
fluence, since they weaken the circulation 
at a time when the woman has need of all 
her strength. 



ERUPTIVE FEVERS. 101 

We have not placed anjemia on the 
list, yet in its marked or pernicious form 
it certainly belongs in the category. The 
patient is already so enfeebled by the dis- 
ease that the shock of labor might be fatal 
in its result; the child, too, would inherit 
a weak constitution, if, indeed, it survived. 

The influence of the eruptive fevers 
upon a pregnant woman is so serious that 
every precaution should be taken to isolate 
her from possible infection, the old idea 
that she is not liable to " catch " infectious 
diseases being quite erroneous. The ex- 
pectant mother cannot be too careful not 
to expose herself to the danger of conta- 
gion, for her own sake as well as that of 
the unborn child. This class of diseases 
tends to produce miscarriage, to cause 
haemorrhage, and to affect the foetus. 

Small-pox epidemics usually give rise 
to many miscarriages and premature la- 
bors. Some authorities state that this 
disease attacks women who are pregnant 
more often than any other eruptive fever. 
It is apt to cause miscarriage and severe 
haemorrhages. The child is often born with 



102 SCARLET FEVER — MEASLES. 

the eruption or the scars upon the body, or 
the eruption may be developed eight or 
ten days after birth. Any woman in a 
family way, and exposed to small-pox, 
should be vaccinated at once, even if she 
have been vaccinated before. It is not, 
however, likely that the child within the 
uterus will be affected by this vaccination, 
therefore it should be subjected to the 
same treatment soon after birth. 

Scarlatina, or scarlet fever as it 
is commonly called, is apt to be more fatal 
when it occurs just after confinement than 
before. The disease occurs rarely in preg- 
nancy, and is somewhat modified by the 
condition. 

Measles is a rare complication, but 
when it occurs is serious from its tendency 
to produce miscarriage and haemorrhage 
and to predispose to pneumonia. The foe- 
tus is apt to be infected, and may have 
the disease before birth or directly after. 

Erysipelas is a complication to be 
dreaded after childbirth, but is not so 
serious during pregnancy. 

Of thenon eruptive fevers, typhoid and 



MALARIAL FEVER— RHEUMATISM. 103 

typhus occur rarely, but, when they do, 
are apt to produce miscarriage. 

There is a prevalent idea that pregnancy 
lessens the chances of incurring malarial 
fever, and to a certain extent this ap- 
pears to be true, although some authori- 
ties think it is due to the fact that preg- 
nant women are usually more carefully 
guarded than at other times, and there- 
fore less exposed to the malarial poison. 
Nevertheless it does sometimes occur, 
and while it is not increased in severity by 
the condition, it is apt to react unfavor- 
ably upon both mother and child. Mis- 
carriage or premature labor may be caused. 
The foetus is likely to be affected by the 
disease, cases being on record where it was 
seized by periodic convulsive movements 
within the uterus. Sometimes it develops 
the symptoms of malarial poisoning soon 
after birth. Occurring in the mother just 
after confinement, it predisposes to haemor- 
rhages, and it has the effect of diminish- 
ing the secretion of milk. 

Rheumatism of the uterus may 
occur in women who have a tendency to, 



104 PNEUMONIA. 

or who have suffered from, general rheu- 
matism, and is characterized by pain or by 
a sensation of distress in the uterus with- 
out apparent cause. The pain frequently 
changes its place, going from one side of 
the uterus to the other, increasing and 
diminishing, sometimes causing a drag- 
ging sensation and heaviness that extend 
to the thighs, the external genital region, 
and the lower part of the back. Pressure 
increases the pain, as do active movements 
or straining efforts. The pain may sud- 
denly leave this region and appear in 
some other part of the body. As rheuma- 
tism seems to have a predilection for mus- 
cles, and as the walls of the uterus are 
composed of muscular tissue, it is nowise 
remarkable that they should sometimes be 
the seat of the affection. It is not a dan- 
gerous complication, but it causes much 
pain and may predispose to miscarriage. 
It may seriously retard labor by increasing 
the suffering and interfering with the 
proper action of the abdominal muscles. 

Pneumonia is a very serious complica- 
tion of pregnancy. The blood is less rich 



SIMPLE JAUNDICE. 105 

than at other times, and the heart less well 
nourished ; consequently, when the lungs 
become stopped up by such an inflamma- 
tory process as pneumonia, the heart is not 
equal to the task of increasing the force of 
the circulation to make up the difference. 

Simple jaundice may occur during 
pregnancy and exercise no harmful effect. 
It is liable, however, to turn into the in- 
tense jaundice which is a symptom of a 
serious liver complaint and which may 
cause the death of the foetus. 

Our object in enumerating the above list 
of diseases has certainly not been to alarm 
the pregnant woman or to increase her 
nervousness in regard to her condition. It 
has been with the view of impressing upon 
her the importance of increased vigilance 
to meet increased dangers ; the necessity 
for a tenfold greater observance of all hy- 
gienic precautions than at other times, 
scrupulous cleanliness, a rigidly sensible 
and nourishing diet, a sufficient amount of 
exercise and ample supply of fresh air, and 
avoidance of ail possibility of contagion. 
Also, the desire has been to arouse her to 



106 NEED OF AN EXAMINATION. 

the necessity of a thorough medical exami- 
nation. Let her, so soon as she suspects 
pregnancy, put herself under the care of 
her physician and permit a thorough ex- 
amination of her heart, lungs and liver, 
and general condition. 

If, during the course of her pregnancy, 
any of the diseases mentioned above should 
supervene, let her remember that we have 
indicated possibilities only in the result, 
and that to be warned of them in time to 
seek appropriate treatment is usually to 
avert the evil. 



CHAPTER X. 

MISCARRIAGE. 

When the foetus dies and is expelled be- 
fore the end of the twenty-eighth week of 
pregnancy, the process is called abor- 
tion, or, in popular language, miscar- 
riage; after the seventh month, when the 
child has a chance of life after its expul- 
sion, it is termed premature labor. 

Labor at term is a natural or physiologi- 
cal process Not so miscarriage, which is 
unnatural and to be classed with diseases. 
It is far more harmful in its effect upon 
the system than childbirth, and the dan- 
gers attending it are very great, particu- 
larly the danger of an exhausting or fatal 
haemorrhage. 

If the majority of women understood 
• this fact more clearly, it is possible that 
they might be more cautious about en- 
deavoring to avoid the trials of maternity 
by destroying the foetus. Leaving aside 



108 MISCARRIAGE. 

the moral question involved, and the fact 
that the operation which they frequently, 
in the calmest manner, demand of their 
physician, is a State's prison offence, a con- 
sideration for their own physical welfare 
should restrain them from overturning the 
laws of Nature. 

The existence of certain conditions in 
which childbirth would endanger the life 
of the mother is considered by law to jus- 
tify the induction of miscarriage or of 
premature labor by the physician ; a de- 
formed pelvis, or one too small to allow of 
the passage of the child's head, Bright's 
disease, and some other maladies belong 
to the category. The doctor is obliged to 
exercise the greatest judgment in deter- 
mining what physical state calls for his 
intervention, and what time is the best 
suited to the purpose ; and when the opera- 
tion is performed it is done with every 
possible precaution to avoid the danger of 
blood-poisoning and to control haemor- 
rhage. The woman who endeavors to rid 
herself of her unborn child knows nothing 
of these precautions ; she swallows power- 



MISCARRIAGE. 109 

ful drugs of whose action upon her system 
she is completely ignorant, and subjects 
herself to mechanical violence which is 
in itself harmful and which may lead to 
blood-poisoning and to many other evils. 
Some, it is true, escape injury ; but how 
many are rendered sufferers for years, 
only the clinics and the practice of physi- 
cians tell. This ignorance or carelessness 
of results is so widespread in this country 
that foreign scientists call the production 
of abortion the " American sin/' for which 
reason we have deemed allusion to it to be 
in place. 

Miscarriage, then, from a medical or 
hygienic point of view, is a misfortune ; 
an accident to be dreaded and, if possible, 
avoided. The causes are various. Some 
women seem to have a tendency to mis- 
carry, apart from any known cause. One 
authority claims that temperament has 
a marked effect — for instance, plethoric 
persons being predisposed to congestive 
troubles and haemorrhage, lymphatic peo- 
ple often being subject to a certain weak- 
ness of the organs of generation, and those 



110 MISCARRIAGE. 

of a nervous temperament being liable to 
suffer contractions of the uterus from very 
slight stimulus. 

A markedly delicate constitution, by not 
allowing sufficient nourishment to the 
foetus, may cause its death and expulsion. 
Obesity, poor food, prolonged inaction 
predispose to the trouble. All the diseases 
mentioned in the preceding chapter are 
likely to cause either miscarriage or pre- 
mature labor. Diseases of the uterus, 
inflammation, tumors and displacements 
(especially when the uterus is tipped and 
curved backward) cause the accident. 
Constipation, by occasioning violent strain- 
ing efforts, and by the accumulation of 
waste matter in the rectum causing a con- 
gestion of blood in the pelvic organs, and 
by direct pressure of distended intestines 
upon the uterus, can readily produce the 
condition, as may uncontrollable vomiting 
and coughing. A tendency to miscarry is 
sometimes more marked at the date corre- 
sponding to the monthly period. Causes 
from without are largely instrumental in 
bringing on miscarriages, as, for instance, 



MISCARRIAGE. Ill 

violent exertion, over-fatigue, falls, stum- 
bling, blows on the abdomen, lifting heavy 
weights, strong purgatives, tight clothes, 
the prolonged use of the sewing machine, 
violent mental emotions, shock, fright. 
No general rule can be given, for women 
differ widely in their tendency to mis- 
carry, in some a very slight cause sufficing 
to start the process, while others seem able 
to bear almost any amount of fatigue and 
exertion without ill effect. Prudence and 
caution would better be observed, however, 
even in the very robust. 

Certain diseases of the foetus itself may 
cause miscarriage. The earlier an abor- 
tion occurs in pregnancy the less is it 
fraught with danger. The symptoms are 
usually pain and haemorrhage ; both in- 
crease in severity with the advance of 
gestation. Sometimes the miscarriage is 
very sudden, but as a rule more or less 
marked symptoms precede it. These are, 
a feeling of lassitude, a sensation of weight 
and fulness in the abdomen, chilliness, 
a frequent desire to pass water, a white 
discharge from the vagina followed by a 



112 MISCARRIAGE. 

slight discharge of blood. Or there may 
be decided pain in the back and in the 
abdomen, the latter occurring at regular 
intervals and increasing in severity. The 
flow of blood becomes more profuse, and 
the foetus is finally discharged. In some 
cases the flow is suspended for days or. 
even weeks, and then reappears with re- 
newed intensity. The foetus may be dis- 
charged in fragments, and some portions 
remaining behind may decompose within 
the uterus and cause blood-poisoning. If 
left to themselves these portions may be 
discharged in the course of time, but it is 
imperative to summon a physician and 
have them removed in order to avoid seri- 
ous consequences. 

In order to prevent miscarriage the 
pregnant woman should be exceedingly 
careful to avoid strains, jars, excessive 
fatigue, violent excitement, etc., etc. If 
she have a tendency to abortion she should 
be particularly watchful at the time corre- 
sponding to her menstrual epochs; anaemia 
and all other existing diseases must be 
appropriately treated, and malpositions of 



MISCARRIAGE. 113 

the uterus corrected by the physician. 
Marital intercourse must be forbidden. If 
the symptoms of a miscarriage appear, 
the patient must lie flat in bed and send 
for the doctor. Everything that she 
passes from the vagina must be saved and 
shown to him. She must keep as quiet as 
possible, both physically and mentally, but 
she need not take the advice of those who 
would surround her with hot-water bottles 
or with ice bags. Heat increases the ten- 
dency to flow, and ice is an extreme mea- 
sure which is scarcely necessary. If no 
doctor is obtainable, let her send to the 
druggist's for the fluid extract of viburnum 
prunifolium, and take a teaspoonf ul of it 
every two hours, or take a quarter of a 
grain of morphine if she can get it. She 
must remain in bed three or four days 
after the symptoms of the threatened abor- 
tion subside. 

If miscarriage occur she must remain 
in bed ten days or a fortnight, bearing in 
mind that the tendency to haemorrhage is 
greater than after a natural labor. 

Premature labor sometimes occurs from 

8 



114 MISCARRIAGE. 

the same reason that do abortions, and 
sometimes physicians bring it on artifici- 
ally in order to benefit the mother's health 
or save the child's life. There is a preva- 
lent notion among women that a seventh- 
month child has a better chance of sur- 
viving than an eighth-month child, which 
is nonsense, the reverse being the case. 
The nearer term a child is born the better 
developed will it be and the greater will 
be its chance for life and strength. The 
treatment during and after premature 
birth is the same as for labor and term. 

A discharge of blood occurring at any 
time during pregnancy, whether large or 
small in amount, sudden or consisting of a 
perpetual little dribbling, should put the 
patient upon her guard and cause her to 
send for medical advice, while she is care- 
ful to lie down and to avoid all fatigue or 
mental excitement. 



CHAPTER XL 

PREPARATIONS FOR CONFINEMENT. 

The preparations for confinement are 
important and should be attended to early, 
lest labor come suddenly and prevent. 

The room chosen should, if possible, be 
large, sunny (in winter) and well venti- 
lated, and removed from the vicinity of the 
water closet. If there is a stationary 
wash basin it should be tightly covered 
with a piece of wood ; and Piatt's chlorides 
may be poured down the pipe so as to fill 
the trap, that there may be as little danger 
as possible of poisoning from sewer gas. 
Everything in the room must be scrupu- 
lously clean, and the fewer the hangings 
the better. Let the furniture include bed, 
chairs, bureau, and one or two tables which 
are to be given up to the physician's use. 
If they are of common wood, like kitchen 
tables, it will be all the better; or they may 
have clean towels spread over them, or oil- 



116 PREPARATIONS FOR CONFINEMENT. 

cloth, or several thicknesses of clean paper, 
in case of the overturn of medicines, etc. 
A bureau, chest of drawers, or shelves of a 
closet should be near at hand, containing 
towels, sheets, napkins, and the baby's 
clothes. 

A single bed is more easily managed 
than a double one; still the latter may, and 
in this country will usually have to be 
used. If preferred, a cot can be used for 
the labor, and the patient be transferred to 
the bed afterward ; this method has some 
advantages, but it is not a necessity. 

A hair mattress is decidedly the best ; 
if it cannot be obtained, as sometimes is 
the case in the country, one of excelsior, 
corn husks, or straw may be used ; but a 
feather bed is to be shunned, unless boards 
are the alternative. As one writer says : 
" It is a combination of every objectionable 
quality. Its use is nearly equivalent to 
putting the patient into an immense poul- 
tice ; it is warm, soft, absorbent, and con- 
sequently nearly always damp. Unless it 
is stuffed unusually full the patient sinks 
at once into a hole ; it is impossible to keep 



PREPARATIONS FOR CONFINEMENT. 117 

it level, and if it once gets wet there is no 
way of renovating it." 

The bed is to be placed in such a way 
that the physician may stand on the right 
side of. it, so that when he faces the pa- 
tient he can use his right hand. It should 
be prepared for labor as follows : Next to 
the mattress there should be a rubber 
sheet, about a yard and a half square, ex- 
tending downward from just above the 
place where the patient's hips will lie, and 
reaching over the edge of the bed. Over 
this is placed a blanket, and then a *h*^ 

Of COttorL, e*UK^ 6l x «^ U xx^j uo uouu ill 

summer if preferred. This is the perma- 
nent dressing of the bed, and should be 
made secure by safety pins. Above it is 
placed a second rubber sheet, blanket, and 
cotton sheet. (The blanket may be omitted 
in both dressings, but adds to the comfort 
of the patient.) An old clean sheet, folded 
several times, may be placed across the 
bed, under the patient's hips, to receive 
discharges, or a pad made of clean bran 
or of prepared jute contained in a cheese- 
cloth bag. The covering sheet and blan- 



118 PREPARATIONS FOR CONFINEMENT. 

kets are next put on, and the bed is in 
readiness. At the conclusion of labor, 
after the mother is washed and cleansed, 
the upper rubber sheet, with whatever lies 
between it and the patient, is removed, and 
a clean bed remains beneath. "When rub- 
ber sheets cannot be obtained, oil-cloth, 
such as is used for covering kitchen tables, 
may be substituted ; it is inexpensive. 

Whatever comes in contact with the 
patient must be scrupulously clean. 
This should be an axiom of labor. The 

TneTc±b f or ** wil1 be S iven a little later - 
i uxiiig ,»^^ „^ xl> ^ woman at the 

time should consist of a flannel undervest 

(thick in winter, gauze in summer), 

night-gown, and stockings. In some h( 



,- w » ~-~n S o. iu oumB Hos- 
pitals stockings extending half-way up 
the thighs are made of canton flannel and 
pulled on when the woman takes to the 
bed. They are easily made, as they must 
ht very loosely, they add much to the 
comfort of a modest woman, and they 
prevent chilling. A wrapper should be 
worn over the night-gown while sitting or 
walking about the room in the first stage 



PREPARATIONS FOR CONFINEMENT. 119 

of labor. When the woman lies upon the 
bed for the second stage, it and the vest 
may be folded or rolled well above the 
hips, that they may not be soiled ; if pre- 
ferred, an old (but clean) sheet may be 
several times doubled and fastened about 
the waist, opening in front, replacing the 
folded sheet or pad which was placed 
upon the bed to receive discharges. There 
should be a full supply of merino, flannel, 
or silk vests, and of night-gowns, in order 
that they may be changed every day, as 
nothing adds more to her well-being and 
comfort than clean clothes. Loose flannel 
jackets with wide sleeves may be worn 
over the night-gown in bed for warmth. 
Two or three binder bandages, about half 
a yard wide, and long enough to go once 
and one-third around the body (about a 
yard and six inches), should be provided. 
They are best made of unbleached muslin 
and pinned with ordinary or safety pins, 
as will be described later. Clean clothes 
for the mother should in winter be warmed 
by the fire, stove, register, or in the sun. 
There should be a liberal supply of linen 



120 PREPARATIONS FOR CONFINEMENT. 

napkins, for after labor these need to be 
constantly changed to keep the discharges 
from decomposing. If the patient's re- 
sources permit, let her by all means pro- 
cure or make, instead of the napkins, 
"antiseptic pads" (anti-septic means 
" against poison 9 % 

The disease known as puerperal fever or 
childbed fever, and called by physicians 
"septicaemia," used to be the scourge of 
childbirth ; a committee of a Berlin society 
appointed to investigate the subject re- 
ported that from ten to fifteen per cent of 
the deaths occurring among women during 
the child-bearing period were due to puer- 
peral fever, and that this disease destroyed 
almost as many as small-pox or cholera. 
As one authority said, "to be laid on the 
bed of confinement was equal to being de- 
livered to the hangman." Many were the 
views held as to its cause ; in the last cen- 
tury a physician advocated what scores of 
non-scientific people believe to this day, 
that some irregularity in the secretion of 
milk was to blame. "Milk-leg," "milk 
gone to the brain," "milk in the joints" 



PREPARATIONS FOR CONFINEMENT. 121 

are expressions which testify to the belief 
that the milk wandered about the body in 
an aimless and erratic manner. In the 
middle of this century it was discovered 
that the disease was due to the entrance 
of some poison into the body from the 
outside, and that this poison could be 
destroyed by disinfectants ; later the im- 
mense strides taken in accurate scientific 
knowledge proved beyond question that 
puerperal fever was a form of blood-poi- 
soning, caused by the entrance of a germ 
or bacterium into the body through the 
wounds made by labor. Methods of pre- 
venting its entrance were next studied, 
with the result that the death rate from 
this cause has been reduced from fifteen to 
less than one per cent. The first and most 
important of these methods is absolute 
cleanliness. Nothing favors the growth 
of bacteria causing this or any other dis- 
ease so much as dirt. Consequently the 
freer the sick-room from lodging places for 
dirt, such as old or upholstered furniture, 
draperies, carpets, etc., the better the out- 
look for the patient. Soiled napkins, 



122 PREPARATIONS FOR CONFINEMENT. 

towels, or clothes, vessels containing dis- 
charges or dirty water, are so many breed- 
ing places for germs and should not be 
allowed to stand in the room. Ventilation 
should be thorough, that floating particles 
of dust may be removed; while the woman 
herself, every article which comes in con- 
tact with her, and the clothes and hands 
of every person who attends to her should 
be scrupulously, absolutely clean. The 
physician and the trained nurse will of 
course be vigilant in this respect ; the hints 
here given are for the benefit of those who 
cannot see their doctor often, and whose 
attendants are not skilled in the modern 
nursing of midwifery cases. Cleanliness, 
then, is the first requisite. 

Antiseptic pads, to be worn over the 
vulva after childbirth, are desirable. They 
may be purchased in the cities at a good 
pharmacy, in the shape of bichloride gauze, 
borated gauze, or salicylated gauze, and 
simply cut into the proper lengths and 
made of the requisite thickness. They are 
somewhat expensive, but by far the best 
since they come already prepared. If, 



PREPARATIONS FOR CONFINEMENT. 123 

however, they prove too expensive, very 
good pads may be made at home of cheese 
cloth folded many times until it is about 
half an inch thick and of the width and 
length of a napkin when ready for use. 
A solution of bichloride of mercury is the 
best antiseptic to use in the preparation of 
these pads ; but as this substance is very 
poisonous, and from its lack of color easily 
mistaken for other liquids, it should be em- 
ployed only under the physician's direc- 
tion. Creolin, however, is an excellent 
antiseptic, which, on account of its milky 
color and its characteristic odor, cannot 
be mistaken for anything else. Five tea- 
spoonfuls of it added to a quart of water 
will make a two-per-cent solution, which 
can be used to wash the vulva as well as 
to prepare the pads. These should be 
wrung out in the creolin solution and 
dried, after which they are ready for use. 
They should be thrown away after using. 
If preferred, napkins may be used by pre- 
paring in the same way, or a pad may be 
reinforced by a prepared napkin to secure a 
thicker covering to the vulva. Absorbent 



124 PREPARATIONS FOR CONFINEMENT. 

cotton may be used instead of, or in addi- 
tion to, the cheese cloth. These dressings 
are to be changed four or five times a day 
during the first week after delivery. 

Carbolic acid may be used, in the pro- 
portion of two teaspoonfuls to the pint of 
water, but its odor is so unpleasant that 
the creolin will usually be preferred. 

The list of articles to be provided 
for the mother's use is as follows : 

A new fountain syringe holding at least two 
quarts of water. 

A dozen sheets, absolutely clean. (Fewer will do, 
but it is desirable to have as many.) 

Towels in abundance for the use of doctor and 
nurse. 

Two rubber sheets or table oil -cloth, each one and 
a half yards wide. 

An oil-cloth or rubber mat to put by the side of 
the bed. 

Two blankets to use in making the bed as directed 
above. 

Some old cotton sheets. 

Cheese cloth, freshly boiled, for wash cloths. 

Cheese cloth and creolin solution for pads. 

A bedpan. 

Two or three binders of unbleached muslin. 

A clean tin or papier mache basin which can be 



PREPARATIONS FOR CONFINEMENT. 125 

slipped under the patient's vulva to receive the after- 
birth, and which must be afterward thrown away. 

Three clean hand basins of agate or earthen ware 
for physician's and nurse's use. 

A slop jar loith a cover. 

Two new nail brushes. 

Castile soap. 

A flask of brandy. 

For the baby there should be provided 
the following articles : 

A yard or two of strong linen bobbin or Chinese 
silk to tie the cord. 

A small old blanket or square of soft flannel in 
which to envelop the child immediately after birth. 

A bottle of sweet oil. 

A pair of blunt scissors 

A soft hair brush. 

A powder box and puff, with talc powder or 
starch or lycopodium powder. 

Castile soap. 

Some soft towels. 

A soft sponge. 

Baby's bath tub ana thermometer. 

Pincushion with safety pins. 

Some squares of clean, soft linen or muslin four 
inches wide. 

A flinnel shawl about a yard square. 

Fine flannel bands. 

The baby's clothes. 



126 PREPARATIONS FOR CONFINEMENT. 

In regard to this last item, the chief 
thing to be remembered is that the cloth- 
ing should be warm and the articles as 
few in number as practicable. There is 
no sense in tormenting an infant by in- 
tricacies of dress. Mothers pin a band 
around the child's abdomen so tightly that 
it can scarcely breathe ; put on diapers so 
large and clumsy that the poor little legs 
are pushed out of their natural position ; 
put on one garment after another, re- 
peatedly turning baby over on its back, 
then on its front, pulling the arms up and 
through tight sleeves, buttoning, pinning, 
fastening the while, and then, with admi- 
rable logic, wonder why the baby cries, 
overfeed it to stop its wails, or give it 
some remedy for stomach-ache ! ! 

A soft flannel shirt, high-necked and 
long-sleeved, and opening in front, should 
go next to the body; then a band of flan- 
nel not hemmed at the edges; next, a 
diaper of linen a yard in length and half 
a yard wide, which is to be folded twice; 
then a flannel dress about twenty-five 
inches long from neck to hem, also open- 



PREPARATIONS FOR CONFINEMENT. 127 

ing in the front, and over this a muslin 
slip. Woollen knitted socks, long in the 
leg, finish this costume, which is the one 
used in the Woman's Hospital of Philadel- 
phia, and has much to recommend it, in 
that it is sufficiently warm without being 
heavy, has not a series of skirts upon 
waistbands, which are really superfluous 
and bulk} r , and by fastening in front is 
simply adjusted and prevents the child 
from lying on buttons, pins, or knots. If 
desired the outer slip can be made to 
fasten behind. 

Some persons prefer to have a set of 
garments made, each a little larger than 
the other, and arranged together before- 
hand, slipping them on at one time. 

In preparing a baby's wardrobe the ex- 
pectant mother can of course collect as 
many dainty and beautiful little articles 
as she may desire, and her friends usually 
enjoy adding pretty specimens of their 
handiwork to the collection. Where econ- 
omy is needful it is well to know the abso- 
lute necessaries. These are, three dozen 
linen diapers, eight or ten soft flannel 



128 PREPARATIONS FOR CONFINEMENT. 

night-gowns, eight or ten flannel day- 
slips, eight or ten muslin slips, six flannel 
shirts, six pairs of socks, three flannel 
bands, a little flannel or knitted shawl, 
and two or three flannel jackets. The 
number of each article can be increased 
as desired, and a warm hood, cloak, and 
afghan added. 

A little crib or bassinet should be pre- 
pared, but not a rocking cradle. A large 
clothes hamper makes a good bed, and 
many a baby has slept comfortably in a 
bureau drawer placed upon two chairs, 
with a pillow for a mattress. 

The French have a nice little contri- 
vance, called a maillot, which might well 
be imitated here. It consists of a thin 
mattress covered by a slip. The slip has 
wings which meet in front and are tied 
together by tapes, enfolding baby, who 
lies on its back on the little mattress. 
Some have a footpiece, but this is too con- 
fining. It is a comfortable little affair, 
and the baby can be laid down for a 
moment on table or lounge without danger 
of rolling off. 



PREPARATIONS FOR CONFINEMENT. 129 

To return to the preparations for labor. 

There should be close at hand some 
means of rapidly heating water. In the 
city it is well to have a small gas stove in 
a closet or adjacent room, with a kettle of 
water upon it; in the country the stove in 
the living room should have a brightly 
burning fire, over which is a large boiler 
full of water. Warm water will be needed 
by physician and nurse for thorough 
cleansing of their hands before, during, 
and after labor; it will be needed to wash 
the mother and to bathe the child; and 
some very hot water might suddenly be 
wanted by the doctor to check haemor- 
rhage from the uterus. Ice should also 
be obtainable. When the second stage of 
labor (to be described in the next chapter) 
is reached it is well to have the following 
objects arranged upon a table for the doc- 
tor's use: a basin *in which to wash his 
hands, and a jug of warm water near it; 
castile soap and a new nail brush; another 
basin which he may use for bichloride of 
mercury solution; a bottle of creolin, a 
bottle of vinegar, scissors, and a pile of 



130 PREPARATIONS FOR CONFINEMENT. 

clean towels. The hot water, as said be- 
fore, should be near at hand, and ice ob- 
tainable at a moment's notice. The recep- 
tacle for the afterbirth should be within 
reach. The bed, of course, will be pre- 
pared and the bedpan close at hand. A 
clean night-gown and undershirt will be 
warming and ready for use if needed, as will 
the antiseptic pads and napkins. Safety- 
pins should be accessible. The receiving 
blanket for the baby will also be warming; 
the scissors and linen bobbin, with four or 
five squares of clean linen, will be in the 
nurse's apron pocket, or on the table with 
the articles for the doctor. These careful 
preparations save confusion, bustle, and 
delay at the important moment. 

Arrangements for the baby's bath and 
toilet will be, if possible, in another'room. 
Here will be bath tub, hot water, the toi- 
let articles already described, soft towels, 
squares of soft linen, the bottle of oil, the 
baby's clothes, all near the fire, with a low 
chair for the nurse or whoever washes the 
infant. 



CHAPTER XII. 

THE STAGES OF LABOR— DIRECTIONS FOR 
THE CONDUCT OF LABOR IN EMER- 
GENCIES — AFTER-CARE OF 
MOTHER. 

Labor is the act of delivery or birth. 
Its approach is heralded about two weeks 
previously by a slight decrease in the size 
of the abdomen, caused by the i€ settling" 
or descent of the child's head into the 
pelvic cavity. Pressure being diminished 
above, the patient is usually able to breathe 
with more comfort, and disturbances of the 
stomach and palpitation cf the heart are 
lessened. Increased difficulty in walking 
may, however, be experienced, swelling of 
the lower limbs is apt to be increased, 
there is a constant desire to pass water, 
sometimes diarrhoea occurs, and any ten- 
dency to piles is aggravated. A more or 
less abundant discharge comes from the 
vagina, which with the near approach of 



132 THE STAGES OF LABOR. 

labor may become tinged with blood, and 
is called the " show." Pains are very lia- 
ble to occur a few days or even a fortnight 
before labor, and the patient has many 
false alarms. These pains are usually of 
the nature of cramps in the abdomen; they 
come on at regular intervals, and usually 
during the early hours of the night. Real 
labor pains, as a rule, start in the lower 
part of the back and gradually extend 
forward to the abdomen and downward to 
the thighs. They occur at regular inter- 
vals, which become less and less until only 
a few minutes intervene. 

Before describing the course of labor it 
is well to recall to mind that the uterus is 
a muscular bag which has grown and been 
stretched until it is now large enough to 
contain a child from six and a half to ten 
or more pounds in weight, a "placenta" 
or afterbirth, membranes, and an average 
amount of from one to two pints of fluid. 
The lower part of the uterus which ex- 
tends into the vagina is small, and is 
called the cervix or neck. The child usu- 
ally lies with its head down and bent for- 



THE STAGES OP LABOR. 133 

ward upon its chest, its back to the front 
of the mother, its arms folded across the 
breast, the knees bent upward toward the 
middle of the body. A new-born infant 
always shows a tendency to double up its 
arms and legs from force of habit. 

The navel string, or umbilical cord, which 
contains a vein and two arteries, leads 
from the child's navel to the afterbirth. 
It is about twenty inches long and about 
the thickness of the little finger. The arte- 
ries and vein are protected by a covering 
of gelatin and a membranous sheath. A 
closed bag of membranes completely en- 
closes the child and contains the fluid in 
which the infant floats. 

When " term " is reached the process of 
labor begins. The muscles forming the 
walls of the uterus begin to contract and 
the child is pushed downward. The first 
thing to be accomplished is the opening 
out or " dilatation " of the cervix, which 
must, from a small, spindle-shaped body, 
become as wide as the vagina and lower 
part of the uterus, in order that there may 
be no obstacle to the child's exit. The 



134 THE STAGES OF LABOR. 

child's head is ill-fitted by its size and 
shape to perform this task, hence Nature 
has provided a wedge in the " bag of 
waters." Some of the fluid by gravitation 
falls in front of or just below the infant's 
head, and, enclosed in the membranes, is 
with each contraction pushed further into 
the cervix. This is not the only cause of 
the opening out of the cervix, but it greatly 
facilitates the process. When the dilata- 
tion is so far advanced that the diameter 
of the opening is about three and a half 
inches, the membranes become so stretched 
that further pressure breaks them and the 
water is expelled. This is the ' * bursting 
of the bag of waters." An amusing story 
is told of a young medical student who, 
being left in charge of a confinement case, 
fled from the scene in alarm and despair 
when the membranes ruptured, thinking 
that the bladder had burst ! 

If the membranes do not open directly 
in the centre, but toward one side, the head 
of the child when it pushes forward may 
carry a bit of membrane upon it. This is 
the lucky "caul" of which so much has 



THE STAGES OF LABOR. 135 

been said by midwives, and which some 
parents carefully preserve to insure the 
child's good fortune ! When the cervix is 
completely stretched, if the membranes do 
not rupture of themselves the physician 
usually breaks them so as to prevent de- 
lay. It is by feeling the cervix and deter- 
mining the amount of dilatation that the 
doctor is able to decide how far labor has 
progressed and whether there is any delay 
in the natural process. The patient should 
always be willing to submit to the exami- 
nation which the conscientious physician 
must make. Sometimes the bag of waters 
breaks very early — long before the cervix 
is opened out. This may somewhat delay 
matters by causing a " dry labor." 

The complete dilatation of the cervix 
ends what is known as the first stage of 
labor. This, in the case of women who 
have never borne children before, usually 
lasts about sixteen hours, and is by some 
women considered the most trying period 
of all. The pains are of a nagging, teas- 
ing, or cutting and grinding character, 
and seem to accomplish nothing, although 



136 THE STAGES OF LABOR. 

they are in reality constantly dilating the 
cervix. 

A word as to the meaning of the term 
" pain " as used in this connection. Many 
a woman has voted her doctor unfeeling 
because he asks if she has " good pains/' 
and is satisfied when they are frequent 
and hard. The fact is that by "pain" he 
does not mean the actual suffering, but 
the contractions of the uterus which are 
advancing labor and shortening the period 
of torment. " Pain " is the technical term 
for this contraction ; as suffering accompa- 
nies the muscular act, and as the patient 
cannot know how the process is advanc- 
ing, the only way that the physician can 
estimate the progress made (with the ex- 
ception of an examination) is to ascertain 
the nature and frequency of the pains. 

During this stage the woman should not 
lie down, and as a rule she will not wish 
to do so, but will prefer to sit, to stand, or 
to walk about This position may favor 
the descent of the head. The contractions 
of the uterus are purely involuntary ; she 
can do nothing to hasten them, and strain- 



THE STAGES OF LABOR. 13? 

ing efforts are worse than useless, as they 
only fatigue her and deprive her of the 
strength which she may profitably use 
during the next stage. She should try to 
bear the pains as patiently as possible, al- 
though this is of course difficult. The in- 
tervals between them are a great relief : 
the patient gains strength and courage 
by their means and breathes more easily, 
while the child is saved from the disastrous 
effects of continuous pressure. 

The physician during the first stage 
usually makes an examination, decides 
how far labor is advanced, and leaves the 
patient, to return in a few hours. This 
the suffering woman is apt to consider 
cruel behavior — she is in pain, and thinks 
that her doctor should be with her to help 
her, to hasten matters, and to relieve her 
sufferings. That, however, is not a wise 
thing for him to do. There is absolutely 
nothing to be done to ease her ; drugs 
which lull pain would lessen the contrac- 
tions of the uterus, delay labor, and pro- 
tract her agony ; there is no way of hasten- 
ing this stage. Moreover, the physician 



138 THE STAGES OF LABOR. 

needs to save his physical and mental 
strength for the hard work of the following 
stages, which he will be quite "unfitted to 
perform if he remain continuously in the 
sick-room, listening to every groan and 
complaint and obliged to refuse appeals 
for help. The average physician is not 
made of iron; his sympathies are quick, 
but he is obliged to protect his own nerv- 
ous system for the work required of him, 
instead of spending it in words, and for 
that very purpose he often assumes a quiet 
manner which the patient misinterprets as 
a lack of feeling. Let her wait, and she 
will see his sympathy expressed by skilled 
and arduous work. 

The husband and friends of the woman 
are the ones to help and comfort her at 
this period of labor, but the sick-room must 
not be crowded. Very few people like to 
have spectators of their physical suffer- 
ings, and the presence of her husband and 
mother, or some other dear relative or 
friend besides the nurse, will be all-suffi- 
cient to make the patient feel that sympa- 
thy is felt for her and that help is near at 



THE STAGES OF LABOR. 139 

hand. Any friend who delights in pic- 
turing possible sufferings and detailing 
horrible cases of which she has heard, or 
confinements which she has gone through 
or seen, should, on some pretext or other, 
be removed from the room. It is brutal 
to give anything but encouragement to a 
woman at such a time. Possibly the friend 
intends to mitigate her sufferings by the 
contrast of worse cases, but she forgets 
that where results are still uncertain any 
one with the least fragment of an imagina- 
tion would naturally think, " Perhaps my 
case will turn out to be similar in atro- 
city ! " 

If pressure with the hand upon the 
lower part of the back seems to afford any 
relief, let it be given by the husband or 
some person with strong muscles. Those 
who think that chloroform or ether could 
be advantageously administered during 
the first stage are grievously in error, as 
they would undoubtedly prolong labor. 
The woman's strength should be kept up 
by food, if she will take it; by tea, coffee, 
broth, beef tea, milk — but not by alcohol. 



140 THE STAGES OF LABOR. 

Let her during this stage remove her 
clothing and put on the vest, night-dress, 
and stockings in which she is to be con- 
fined, with a loose wrapper over all. She 
should also have her bowels cleaned out 
by an enema of warm soapy water. This 
is of extreme importance, as otherwise the 
pressure of the child's head on the rectum 
may cause the evacuation of its contents 
during the second stage of labor, which is 
an unpleasant and unfortunate occurrence. 
The bladder should likewise be emptied; 
if twelve hours pass without the patient 
passing urine, the doctor should be in- 
formed, that he may use means for its re- 
moval, as pressure on the neck of the blad- 
der later by the child's head might prevent 
its evacuation and cause serious injury. 

With the complete dilatation of the 
cervix begins the second stage, or stage of 
expulsion. The pains increase in severity 
and frequency, and the muscles of the ab- 
domen now begin to assist. They con- 
tract involuntarily, but the patient can 
increase their contractions by voluntary 
efforts, and should do so. She would bet- 



THE STAGES OF LABOR. 141 

ter lie on the bed at this point, or, if she 
prefer to sit, be near enough to the bed to 
rapidly place herself upon it. If she wish 
it, a sheet or strong piece of cotton may 
be fastened to the foot of the bed, and she 
may pull upon it with each pain, bracing 
her feet against the footboard; but if the 
pains are very strong she would better not 
do this. She may lie upon her back or 
side. The question of posture in labor is 
an interesting one. In England it is usual 
for women to lie upon the left side ; in this 
country the back is usually preferred. 
" The Hindus, as well as the inhabitants 
of Madras and the East Coast, prefer the 
standing position, supported by female 
friends or the husband. This is likewise 
the case with the negroes of the Philippine 
Islands, with the women of Central Africa 
and those of the Boers, as well as many 
Indians. Formerly Frenchwomen were 
delivered in this position, and more re- 
cently the Slavs in Upper Silesia. The 
women of Polynesia, the negresses of Aus- 
tralia, and the Persians (kneeling upon 
three stones) give birth in the squatting 



142 THE STAGES OF LABOR. 

position ; while many Russians give birth 
to the child while swinging and hanging 
from a beam, and the Brazilians are even 
tied to a tree. Others hang to a cord sus- 
pended from the ceiling. Some English 
and German women are supported by the 
husband's arm. In Meeran the parturi- 
ent woman is suspended by a large, strong 
towel and allowed to swing about . The 
Abyssinians, Georgians, Armenians, Per- 
sians, Tartars, Mongols, Kamtschatkans, 
Greeks, and Esthuanians all kneel. The 
Australians, the South Indians and Mas- 
sauanians are delivered seated on a block 
of wood ; the negroes of old Calabar sit- 
ting on a stone; while women in Japan, 
China, Turkey, Greece, Egypt, and Mes- 
sina prefer the chair. This chair is of 
very ancient origin, and has been used 
from the earliest Egyptian times up to the 
present. In old Rome, Holland, Germany, 
and among the Bedouins many preferred 
sitting upon some one's lap. The Brazilian 
Indians, the women of the Antilles, of the 
Sandwich Islands, of Sumatra, Australia, 
Japan, China, Paon, India, are delivered 



THE STAGES OF LABOR. 143 

in the recumbent position, lying on the 
side. The side posture is generally used 
by the Siamese Indians and North Ameri- 
cans. Finally, some Italian women raise 
the body and bend backward so that head 
and feet nearly meet." 

The quotation has been introduced sim- 
ply as being of some interest. In this coun- 
try, as said before, the patient usually lies 
on her back, unless the physician direct 
otherwise. She can, of course, frequently 
change her position, and will be likely to 
do so from restlessness. As the child's 
head pushes down, the bladder will be 
pressed upon and the woman experience 
a constant desire to pass water. Toward 
the last let her restrain herself from get- 
ting up to sit upon a vessel, lest the child 
might suddenly be born in this situation. 

With each pain the child's head advances 
into the vagina; after the pain it retreats a 
trifle, but advances further with the next 
one. Finally the head emerges. At this 
point, to the great distress of the patient, 
the physician sometimes by pressure for- 
cibly holds the head back, which seems 



144 THE STAGES OF LABOR. 

to her needless and cruel. The reason 
is this: That part of the body between the 
vagina and the opening of the rectum is 
called the perineum, and plays an im- 
portant part, too complex to be here de- 
scribed, in supporting the vaginal walls. 
The advancing head bulges and thins 
this perineum, and a sudden movement 
readily tears it. The wound may be 
slight, but in some cases it extends through 
to the rectum, and the after-consequences 
are injurious to health of the parts. 
The tear must either be sewed up imme- 
diately after labor or be rectified by an 
operation later. Now, by holding back 
. the oncoming head so that the perineum 
may become gradually stretched, by pre- 
venting it from rushing through during a 
pain, and by gently helping it through in 
the interval between two pains, the physi- 
cian can very frequently prevent all tear- 
ing, or at least limit it to a slight injury 
necessitating a few stitches only. Tears 
of the cervix are usually beyond control of 
the physician, but by no means occur in 
every case. 



THE STAGES OF LABOR. 145 

After the child's head is born there is a 
short pause, during which it turns so as to 
describe a quarter of a circle, in order to 
bring the shoulders in the best position for 
expulsion. With another pain or two 
these and the rest of the body follow, and 
the mother experiences a sense of immense 
relief. This ends the second stage, which, 
in case of a first confinement, is usually 
about two hours in duration. 

A lull of from five to twenty minutes 
now occurs, during which time the nurse 
is usually busy in attending to the infant, 
in the way to be described later. Then 
with a few more pains the afterbirth is ex- 
pelled and labor is at an end. 

It sometimes happens that the physician 
is unable to get to a case in time, and that 
the nurse or some friend of the patient is 
obliged to conduct labor. A nurse who 
has graduated from a training school will 
know how to proceed, but a few directions 
to the inexperienced may not be out of 
place. 

She should, in the first place, remain 

calm and clear-headed. Let her remem- 
10 



146 THE STAGES OF LABOR. 

ber that, after all, labor is a natural pro- 
cess, and that complicated cases are the 
exception, not the rule. During the first 
stage there is little or nothing to be done. 
During the second the attendant should 
stand by the bedside, and, when the head 
appears in sight at the opening of the 
vulva, she should place her left hand upon 
the perineum — the space between the va- 
gina and rectum — and with the thumb and 
forefinger of the right hand seize the 
child's head and press firmly upon it dur- 
ing a pain, relaxing the pressure, and 
merely keeping her fingers in contact with 
the head, between the pains. This should 
be repeated several times, until finally the 
head emerges. Now let her at once feel 
with her hand around the child's neck, to 
ascertain whether the navel cord is wound 
around it. If so, she should gently and 
slowly draw it down until there is a loop 
long enough to pass over the child's head. 
This will save the infant from strangula- 
tion. If not long enough to slip over the 
head, the cord will at least be loosened, 
and will slip over the shoulders when they 



THE STAGES OF LABOR. 147 

emerge. Let her wait quietly until the 
child's body is expelled, and then, receiv- 
ing it in her hands, lay it gently down be- 
tween the mother's thighs in such a way 
that the cord is not put upon the stretch, 
and that the face is not lying in the dis- 
charges which come from the vagina. 
The mouth should at once be freed from 
any mucus which may be clogging it. 

Meanwhile another assistant should 
place a hand upon the mother's abdomen, 
upon the upper border of the uterus, which 
can be distinctly felt. She should not 
press in her fingers nor lay the hand flat, 
but, slightly hollowing it, lay it on the 
rounded border of the uterus and keep it 
there until the binder is put on. 

No harm will be done if the afterbirth 
is delivered before the child is separated 
from it, but the usual way is to wait a few 
minutes until the pulsations in the cord 
are slow and feeble, then to take a piece 
of flat linen bobbin or of Chinese silk and 
tie it tightly around the cord, about one 
$,nd a half inches from the child's body. 
An inch further away another ligature 



148 THE STAGES OF LABOR. 

should be tied, and the cord cut between 
the two with scissors. Any blood oozing 
from the cord which is attached to the 
child should be wiped off, and the cord 
watched for a few moments to be sure 
that the oozing has ceased. If it still 
flow, another ligature should be tied more 
tightly within the first one. The baby's 
eyes should now be carefully wiped with 
a clean, soft bit of linen, and washed with 
a little borax water (a third of a teaspoon- 
ful of borax to a glass of tepid water) ; 
then baby may be rolled in the receiving 
blanket, laid upon a lounge or bed on its 
right side, and covered with a warm 
shawl. Wherever placed, its presence 
should in some way be indicated, so as to 
prevent its being inadvertently sat upon, 
as has been known to occur. Providing 
that the child be kept warm (it having 
just come from a temperature of nearly 
100° to a comparatively cold outer world), 
and that an occasional glance be given to 
the navel cord to ascertain that there is no 
bleeding, the infant may remain for sev- 
eral hours uncared for, if there be not a 



THE STAGES OF LABOR. 149 

sufficient number of persons to attend to 
both mother and child. Nurses who have 
not been trained in a regular school usu- 
ally think that the child needs washing 
the moment the cord is cut, and run off 
with it to some obscure corner to scrub it, 
leaving the mother in charge of the physi- 
cian alone. The child is no more unclean 
than it has been for months, and can well 
wait until the toilet of the mother, who has 
had long hours of pain and fatigue, has 
been attended to. 

The delivery of the afterbirth consti- 
tutes the third stage of labor, and is the 
time most fraught with danger to the pa- 
tient on account of a possible haemorrhage. 
The physician is very seldom detained so 
long that he cannot arrive in time to attend 
to the expression of the afterbirth, and it 
should be left for him to do, the attendant 
quietly waiting with one hand pressed 
firmly upon the uterus through the walls 
of the abdomen, unless it is known that 
he cannot arrive within an hour, or unless 
there be haemorrhage. In that case, after 
waiting perhaps twenty minutes for the 



150 THE STAGES OF LABOR. 

spontaneous expulsion of the placenta, the 
hand upon the abdomen should be pressed 
firmly downward with a squeezing motion. 
The cord is not to be palled on any pre- 
text whatsoever. The afterbirth will usu- 
ally appear at the vulva, should be seized 
and extracted by turning it round and 
round upon itself, drawing it gradually 
down and out. Together with the mem- 
branes it should be kept for the physician's 
inspection, in order that he may satisfy 
himself that no portion has been left within 
the uterus, after which it should be disposed 
of by burning. The hand upon the abdo- 
men must still remain there, and should 
follow the uterus, which is now about as 
large as a large orange, above the pubic 
bones. If the uterus should relax and 
become large again, the openings of the 
blood vessels, which are closed by the con- 
traction of the organ, will be in danger of 
reopening and causing haemorrhage, hence 
the necessity for firm pressure. The vulva, 
thighs, and any soiled adjacent parts 
should be carefully washed with a solu- 
tion of creolin in water, soiled sheets and 



THE STAGES OF LABOR. 151 

clothing removed, clean garments put on 
if needed, and the antiseptic pad and the 
binder adjusted. The latter, as said be- 
fore, consists of a piece of unbleached mus- 
lin a foot and a half wide, and long enough 
to go around the abdomen once and over- 
lap. The lower border should come down 
well over the hips. Beginning above, it 
should be firmly pinned, but not pulled so 
tight as to be uncomfortable. Ordinary 
pins possess an advantage in that they can 
be placed very close together and secure 
a better-fitting binder ; in the hands of an 
inexperienced assistant the safety pins will 
be better, placed about an inch apart. 
When the front is fastened the binder may 
be pinned or sewed at the sides to adjust 
it to the figure. The pad and napkin may 
be fastened to the lower part of the binder. 
This bandage serves a useful purpose in 
giving a sense of support and comfort to 
the woman, and many believe that it assists 
in preserving the figure. 

When perfectly clean as to person and 
clothes the mother should be left to rest. 
A sense of complete exhaustion will usually 



152 THE STAGES OF LABOR. 

prevent any desire for food, but if she 
wish for a little milk, broth, or beef tea, 
she may have it. 

No one should now be allowed in the 
room except the husband, physician, and 
nurse, for it is desirable that absolute rest 
of mind and body follow the exertion of 
labor. Near relations or a very intimate 
friend may, if the mother desire it> come 
in for a moment, singly, after forty-eight 
hours ; but if the slightest restlessness or 
fatigue be noticed after these visits they 
must be interdicted. It would be better 
if no friends came for seven days, but it is 
useless to expect such self-restraint, there- 
fore we consider it the wiser plan to ad- 
vise that at first they merely step in to 
say a word of congratulation and affection, 
and then immediately withdraw. No one 
should come to the sick-room to hold a 
conversation with the patient under a 
week, if all is going well. To worry the 
young mother with any remarks about her- 
self or the child which are not optimistic, 
to trouble her with any details of house- 
keeping, or to acquaint her with unpleasant 



THE STAGES OF LABOR. 153 

news is intolerable. She should be allowed 
to sleep a great part of the time, and no 
well-meaning friend should read to her or 
talk continuously to her for a week at 
least. 

The air of the room must be kept fresh 
at all times. By carefully covering the 
patient the windows may be thrown wide 
open three times a day for a few minutes, 
even in winter ; in summer they will of 
course be open, unless the noise from the 
street be less endurable than the heat. 

The patient must be kept clean. The 
antiseptic pad is to be changed five or six 
times a day, and the vulva washed with 
the creolin solution. Vaginal injections 
are not to be given unless the doctor 
orders them. The whole body must be 
sponged with warm water and soap (and 
each part wiped immediately after wash- 
ing) every two days, the face and hands 
washed at least twice a day. All soiled 
articles are to be removed at once from 
the room. 

The discharge from the vagina is called 
the lochia, and for two or three daj's fol- 



154 DIET AFTER LABOR. 

lowing labor consists of blood mixed with 
mucus and shreds of membrane. It then 
becomes yellow or pale green, finally thin- 
ner and less abundant, and ends in two 
or three weeks. Cleanliness will usually 
prevent odor, but if, in spite of washing 
with an antiseptic solution, there should 
be a strong and fetid smell, the doctor 
should be told of it at once. 

The binder is to be changed every day, 
and great care exercised to see that it lie 
smooth, as creases irritate the patient's 
skin. 

During the first twenty-four hours 
rather light food should be taken — broths, 
gruels, beef tea, milk, cocoa, dropped 
eggs, tea and toast. On the second day 
chicken, beef, mutton, and other simple 
articles of diet may be taken. The old 
idea of starving a woman after labor was 
absurd ; after such an exhausting experi- 
ence she needs to be sustained and nour- 
ished. Of course care must be exercised 
in the choice of food, and nothing eaten 
which is in itself indigestible or which is 
known to disagree with the patient. 



BOWELS AND BLADDER. 155 

The bowels are usually constipated for 
a few days after labor, On the third day 
ah enema of warm water, or soap and 
water, or water and castor oil, may be 
given, or two tablespoonfuls of glycerin 
or a glycerin suppository may be inserted 
into the rectum. If this is not sufficient 
to produce a movement the physician will 
prescribe a laxative. The bowels must be 
opened daily thereafter. 

The bladder should be emptied every 
eight hours at least. A great many physi- 
cians believe that it is positively beneficial 
to the patient to sit up for the purpose 
of passing urine ; it allows clots and dis- 
charges to escape from the vagina, and it 
often causes the urine to flow when it has 
been found impossible to pass it in the 
recumbent position. If difficulty is expe- 
rienced in passing urine, hot wet cloths 
may be laid on the abdomen just above 
the pubic bone, or the patient allowed to 
sit upon a vessel half -filled with steaming 
hot water. 

The care of the breasts and nipples 
is of the utmost importance. Milk is not 



156 CARE OF BREASTS. 

secreted until the third day, but Nature 
has provided a secretion, called the colos- 
trum, which acts as a laxative upon the 
infant's bowels. After the mother has 
rested about two hours after labor, the 
child should be put to the breast. The 
nipples must be washed with warm water, 
and a little sugared water may be put on 
them if the child shows any disinclination 
to nurse. The mother should turn on her 
side (the right side if the right breast is 
given), and the child's head be supported 
by her arm. The nipple drops toward the 
infant's mouth, and is more easily taken 
than in other positions. Not only is this 
early suckling of advantage to the child, 
but of the greatest benefit to the mother, 
as, through influence of the connecting 
nerves, it excites the uterus to contract and 
thus assists in preventing haemorrhage. 

The milk usually appears on the third 
day, but may be delayed until the sixth, 
and may also be attended by a slight rise 
of temperature with a little restlessness. 
If the breasts are so full of milk as to be 
painful, they may be very gently rubbed 



BREAST BINDER. 



157 



with sweet oil in the direction of the 
nipples, one hand holding up the breasts in 
such a way as to make counter-pressure. 
The patient in such a case should take 
very little liquid food, and would better 
take a laxative, such as Hunyadi water, or 
seidlitz powders, or magnesia. A band- 
age often gives relief, and may consist 



r 



KJ 



3 Feet 
Fig. 4. 

of simply a support passed under the 
breast and over the opposite shoulder, or 
of strips of muslin wound around the 
breast and opposite shoulder several 
times, each successive layer slightly over- 
lapping the one below. A bandage much 
in use is made of a straight piece of 
strong unbleached muslin a yard long and 



158 CRACKED NIPPLES. 

half a yard in width, in which holes are 
cut for the neck and the arms, as shown 
in the accompanying figure, and is both 
simple and efficacious. Part 1 meets part 
2 and is fastened over the shoulder ; 3 
and 4 meet in front and are fastened by 
safety pins. 

The nipple must always be kept per- 
fectly clean, to which end it must be 
washed, before and after each nursing, 
with tepid water, or borax and water, and 
dried with a clean, soft cloth. 

Care of the breasts during pregnancy 
will do much to prevent tender or cracked 
nipples. When they exist, however, dur- 
ing lactation, they require special care, for 
the pain caused by them may become 
agonizing. They may be treated by ap- 
plying daily cocoa butter, cocoanut oil, or 
olive oil; or a little of the compound tinc- 
ture of benzoin may be brushed over them 
with a camel's-hair brush; this will cover 
the cracks with a little film, and at the 
same time relieve the pain and hasten 
a cure. Relief may also be obtained by 
laying on cloths wrung out in a solution 



CRACKED NIPPLES. 159 

made by adding a teaspoonf ul of lotion of 
sugar of lead to a glass of water, or by 
dusting on a little powdered gum arabic, 
or oxide of zinc, or tannin, or by first cov- 
ering the nipple with glycerin and then 
dusting on the tannin. Should all this be 
of no avail a nipple shield must be used 
for a few days. It should fit closely; the 
part nearest the breast should be of glass or 
of metal, and the tip of rubber. It must 
be removed after nursing, thoroughly 
cleansed, and kept in cold water, while 
the breast should be washed with tepid 
water and some one of the substances 
mentioned above applied to the nipple. 

Intense pain is sometimes caused by the 
child's biting the nipple. It is astonish- 
ing what force the little creatures are able 
to exert. The nipple shield is the only pro- 
tection, and must be worn in such a case. 

However great the pain caused by nurs- 
ing with a fissured nipple, we would 
strongly urge the mother to persist in the 
attempt, and not to give it up unless every 
means of relief proves to be a failure and 
the agony too great for endurance. 



160 NURSING OF CHILD. 

Few women realize that their refusal to 
nurse is a veritable calamity to the child. 
Infants fed at the breast are stronger, 
healthier, and far more flourishing than 
those brought up on the bottle, and resist 
diseases much better. Some children do 
fairly well upon artificial feeding, but 
these are the exception, and are usually 
very healthy and vigorous by nature. 
Language is scarcely strong enough to 
emphasize the fact that every mother who 
can do so should nourish her own child 
and permit nothing to interfere with this 
paramount duty. Extreme delicacy, con- 
sumption, epilepsy, or other grave disease 
of course forbids her nursing; fevers, shock, 
grief, all violent mental emotions, render 
the milk unfit for the infant's use; Nature 
sometimes fails to supply milk in the neces- 
sary amount or of suitable quality; social 
conditions sometimes oblige the mother to 
work for the support of herself and child, 
necessitating her absence from home — all 
these cases and some others forbid her 
nursing her own child. But the woman 
who, to save herself trouble or to pre- 



ABSCESS OF BREAST. 161 

serve her figure, deliberately allows the 
supply of milk in her breast to dry, and 
gives her child over to a wet-nurse or 
brings it up on the bottle, is guilty of 
criminal negligence of duty. Her punish- 
ment will be sure to follow, either in the 
delicacy of constitution of her child, in the 
endless annoyances caused by the average 
wet-nurse, or the troubles incident to bot- 
tle-feeding, which are far greater than the 
trouble of nursing. 

Cracked nipples, if neglected, may 
lead to the formation of abscess of the 
breast. When, three or four weeks after 
confinement, the breast becomes hard, hot 
to the touch, swollen and painful, and the 
patient has a chill and fever, the child 
must be kept entirely away from the 
breast, nursing upon the other side only, 
and the physician be at once summoned. 
Poultices must not be applied at this stage, 
as they encourage the formation of pus. 
The physician will endeavor to prevent 
the formation of pus, but in some cases 
this will be an impossibility. The only 

resource then is to open the abscess, and 

11 



162 DURATION OF LYING-IN. 

the sooner this is done the better, for de- 
lay means more pain, much more destruc- 
tion of tissue, slower healing, and a far 
worse scar than does a prompt incision. 
The question, " How long shall the 

PATIENT REMAIN IN BED ?" is a difficult 

one to answer, inasmuch as different cases 
require different treatment. Many a tene- 
ment-house patient gets up and does her 
housework within three or four days, and 
considers her neighbor a lazy creature be- 
cause she lies in bed a full week. She 
may suffer no inconvenience, and she may 
live to repent her temerity. In either case 
her example is not to be followed by the 
woman of average strength. Some pin 
their faith upon a " nine-days " lying-in, 
but this cannot be made into a rule. 

The uterus is gradually returning to a 
normal size, and on the ninth day it has 
usually contracted sufficiently to be con- 
tained within the pelvis ; still this is not 
always the case, and it is far better to err 
upon the safe side and remain in bed too 
long rather than too short a time. No 
doubt it is irksome to stay in one place 



EXAMINATION AFTER LABOR. 163 

after the first exhaustion has passed away, 
but it is also exceedingly irksome to have 
to be treated for uterine disease in later 
months. So long as the discharges are 
tinged with blood the patient must remain 
in bed. If they have ceased to be thus 
tinged, if she feel fairly well, she may on 
the eighth day sit up in bed for half an 
hour ; the next day she may be transferred 
to a lounge, and remain there for a few 
hours lying down. This may be repeated 
the following day, after which, if she have 
not been fatigued by the experiment, and 
if no flow of blood have followed it, she 
may sit up in an easy chair for an hour, 
and increase the period day by day, always 
lying down again the moment that she feels 
fatigued. She must not stand on her feet 
nor walk about for more than a few 
moments until the tenth to the fifteenth 
day, nor go down-stairs in less than three 
weeks, nor out of the house before the fourth 
or sixth week, and then only in very plea- 
sant weather. Two or three weeks after 
labor the physician will probably desire 
an opportunity of examining the young 



164 EXAMINATION AFTER LABOR. 

mother, to ascertain whether there have 
been any tear of the perineum or of the 
neck of the womb. The first of these con- 
ditions is usually repaired immediately 
after confinement, but there are cases in 
which it is not deemed advisable. The 
second condition can be remedied with a 
slight operation at an early date, but if 
neglected may lead to inflammation and 
ulceration, to pain and weakness, which 
will reduce the patient to a state of semi- 
invalidism, cripple her usefulness, deprive 
her of many pleasures, and perhaps years 
later necessitate a really serious operation. 
Therefore permission for the examination 
should be readily granted. 

We have purposely avoided a descrip- 
tion of abnormal labors, since they can- 
not be conducted by nurse or friend. A 
physician's presence is necessary in any 
labor; but whereas directions can be given 
for meeting the emergencies of natural 
labor, the accidents due to malpositions of 
the child and other grave disasters cannot 
be described in a book of this nature, nor 
can directions be given for their treatment. 



CHAPTER XIII. 

CARE OF THE INFANT AFTER BIRTH — 
BATH — DRESSING THE CORD — EXAMI- 
NATION OF CHILD — ATTENTION TO 
BOWELS AND BLADDER — 
SLEEP. 

The care of the child now demands our 
attention. The tying and severing of the 
cord, the washing of eyes and clearing of 
the mouth, have already been mentioned. 
The bath is next in order. Bathtub, 
clothes, towels, etc., are prepared near the 
fire, stove, or register. The nurse sits on 
a low chair, and may have a flannel apron 
or a piece of flannel or soft blanket on her 
lap. The baby at birth is more or less 
covered with a thick, greasy substance 
(called the vernix caseosa), which serves 
the double purpose of protecting it while 
in the uterus and of assisting it to glide 
through the maternal parts during labor. 
This is not to be removed by soap and 



166 CARE OF THE INFANT AFTER BIRTH. 

water, but must be dissolved by means of 
sweet oil or lard. The baby's eyes and 
face should first be washed with a soft, 
clean cloth and dried ; then the oil is thor- 
oughly rubbed on the head and neck, 
which are then washed with the cloth and 
water. The chest, back, abdomen, legs, 
anus, and genital organs are treated in the 
same way, with especial care to cleanse 
between all folds of skin where the vernix 
is thickest. The bathtub is filled with 
water at 95° to 100°, and the baby im- 
mersed in it, the nurse's left hand support- 
ing the neck and head, and her right hand 
rubbing the body. Soap is not necessary ; 
the skin of a newly -born infant is so sen- 
sitive that soap only irritates it When 
discharges from the bowels occur the ad- 
jacent parts may be washed with soap, 
which may also be used upon the whole 
body when the baby is a few days old. 
Pure Castile soap only should be used. 
Upon removing the infant from the water 
it is at once rolled in a warm, soft towel 
and rubbed quite dry. If this is thor- 
oughly done no powder will be needed, 



DRESSING OF THE CORD. 167 

except on the genital region ; talc, talcine, 
powdered starch, or lycopodium are pre- 
ferable to perfumed toilet powders, which 
are apt to contain substances irritating to 
the baby's delicate skin. The baby is not 
put into a bathtub again until after the 
stump of the cord has fallen off, but is 
sponged daily. The genital region should 
be washed with clear water every time 
the diapers are changed (which must be 
done as soon as they are wet or soiled), and 
powder freely applied. Diapers should 
never be used a second time without wash- 
ing. By attention to these details the 
baby is frequently saved from chafing 
and irritation of the parts. 

The DRESSING OF THE CORD is the U£Xt 

process in the care of the child, and here 
the simplest way is the best. It should be 
carefully dried and dusted over with pow- 
dered boracic acid. A piece of borated 
absorbent cotton or soft old linen about 
three inches square, with a hole in the 
centre, is slipped over the stump, which is 
turned upward toward the baby's face and 
to the left side, and the lower portion of 



168 DRESSING OF THE CORD. 

the cotton is turned upward, so that the 
stump lies between two layers of absor- 
bent cotton or of linen. A soft flannel 
belly band is placed over all, and fastened 
by means of double tapes which pass 
around the child's body and are tied in 
front. This bandage should be rather 
loose than tight. The dressing is left on 
until the cord comes away; when it falls, 
on about the fifth day. a small raw surface 
is left. It must be remembered that blood- 
poisoning might occur through this little 
wound, and it must be treated aseptically 
— that is to say, a little boracic acid in 
powder may be dusted over it until it 
heals. After this the flannel belly band is 
no longer needed. 

The old method of greasing the cord 
was harmful ; putting on charred rags was 
in a measure useful, as charcoal is an an • 
tiseptic ; but boracic acid is easily obtained 
at the druggist's and is much better for 
the purpose. When the cord falls off, if 
there should be any bleeding from the na- 
vel (the place of detachment) the doctor 
must be summoned. If there is any delay 



EXAMINATION, 169 

in his coming a little styptic cotton should 
be procured at the druggist's and laid on 
the bleeding surface. Over that a cent 
wrapped in a bit of borated cotton should 
be placed and bound down snugly with the 
flannel band. This may save the child 
from bleeding to death. 

After the cord is dressed there should be 
a careful examination of the child, to 
ascertain whether it is perfectly f ormed, 
whether there is an opening to the rectum, 
etc. Inexperienced persons are sometimes 
alarmed at the shape of the baby's head, 
which immediately after birth is very long 
and drawn out, sometimes with a puffy 
tumor upon it. The bones of the skull are 
not solidly united in an infant, as in an 
adult, but connected by membranes, so 
that as the head descends through the 
bony pelvis and the vagina the bones can 
slightly overlap and thus adapt themselves 
to the size and shape of the canal through 
which it travels. In consequence of this 
" moulding" the head emerges peculiar in 
shape, and it often requires two or three 
weeks for it to become of a natural round- 



170 MECONIUM. 

ness. There should be no pressure on the 
head to " shape" it, which some nurses 
delight to apply. The puffy tumor may be 
found upon any part of the head, and is 
usual in tedious labors. The explanation 
of it is that at the spot where it is formed 
there happens to be no pressure ; the other 
portions of the head are pressed upon by 
the maternal parts, consequently a swell- 
ing results at this point. It is not beauti- 
ful to look at, but it need cause no alarm, 
as it soon disappears. 

The examination of the child being com- 
pleted, its flannel shirt, diapers, and other 
clothes are put on, having a care to fasten 
them with tapes or with shield pins. A 
cap is not needed, as the circulation in 
a child's brain is very active just after 
birth. 

A few hours after birth, as has been said 
before, the infant is placed at the breast. 
The colostrum (the substance first secreted 
by the breast) causes a discharge from the 
bowels of a dark substance called the 
meconium. If this is delayed a day the 
baby should have a pinch of brown sugar, 



SLEEP. 171 

or a teaspoonf ul of sweet oil, whey, or oil 
of sweet almonds. 

If no urine is passed the first day a 
teaspoonful of cold water may be given 
or the child immersed in a warm bath. In 
fact, the baby may have passed water in 
its bath unobserved by the nurse, so that 
no real cause for alarm exists. 

After its first nursing the baby may be 
put to sleep. It is not a good thing to 
put it in the bed with the mother ; it is not 
a healthy way for the infant to sleep, and 
there is danger that the mother may over- 
lay it. A small crib may be drawn up 
near the bed, and if the baby from the first 
is accustomed to sleep in it instead of 
being rocked in a cradle or dandled in 
arms, much future unreasonableness on 
the part of the small sovereign will be 
saved. Moreover, it has been well stated 
that when the baby is in the mother's bed 
its head is often covered with the bed- 
clothes and it breathes impure air, and if 
it is restless the mother is apt to put it to 
the breast to quiet it. This is of all things 
most foolish. A baby is as apt to cry 



172 SLEEP. 

from an overloaded stomach as from an 
empty one, and the effect of soothing it 
with a little more milk is like that obtained 
from eating a second dinner to stop dys- 
pepsia caused by the first. Often the trou- 
ble is thirst ; this is not quenched by milk, 
which is a food and not a drink. A little 
sweetened water will frequently cause a 
cessation of the trouble. 



CHAPTER XIV. 

DEBILITY IX THE NJEWLY-BORN — 

APPARENT ASPHYXIATION — 

CARE OF THE EYES. 

The child is not always born in the 
healthy, normal condition which was 
taken for granted in the last chapter. 

From various causes it may be dead 
when delivered, and the utmost sym- 
pathy must be felt with the poor mother 
who has borne so much discomfort for so 
long a period/ and such pain at the last, 
only to be disappointed in her hopes and 
plans. People are too apt to dismiss the 
subject lightly from their minds, giving 
little pity, because the child had not lived 
long enough for its parents to become at- 
tached to it, nor for its absence to create 
any sense of loss. Unquestionably a child 
endears itself daily, and its death at a later 
period is harder to bear ; nevertheless the 
mother usually feels a warm love for her 



174 DEBILITY IN THE NEWLY-BORN. 

babe long before its birth, its untimely 
death causes more sorrow than is under- 
stood by her friends, and the effect upon 
convalescence must often be marked. The 
tenderest care and consideration should be 
shown to her, and everything done to con- 
sole and uplift her spirit, not underrating 
what her loss has been to her, nor seeking 
to persuade her that her child was too 
young to have had any individuality and 
that therefore its death is not to be 
mourned. To a woman with delicately 
organized nerves this thought would be 
pain rather than comfort. Let her rather 
be encouraged to think that her child ex- 
isted for a while for a definite purpose — 
perhaps that she might in its memory do 
some good thing for some other child in 
one of the thousand little ways that will 
suggest itself to the kind heart and fertile 
brain. Such a thought as this will do 
much toward sustaining her, and toward 
inducing her to co-operate heartily with 
physicians, nurses, and friends in the 
effort to regain health and strength. 

The child may, when born, present signs 



DEBILITY IX THE NEWLY-BORN. 175 

of extreme debility; it may be ema- 
ciated, its skin pale or bluish in hue, its 
breathing difficult, and its voice moaning 
instead of lusty and vigorous. In a hos- 
pital such cases (often those of prematurely 
born infants) have frequently recovered 
by being placed in a couveuse, or incu- 
bator, a box so arranged that while there 
shall be perfect circulation of air within 
it, the child is kept in an atmosphere of 
great heat. In the hospital in Paris where 
this apparatus has been used for several 
years the mortality of prematurely born 
children has decreased from 66 to 36.6 per 
cent. 

Persons living at home cannot, as a rule, 
have such an apparatus, nor do physicians 
keep them on hand. The hint to be taken 
from them, however, is to keep the child 
as hot as possible — from 98° to 100°. The 
room must be extremely warm, the infant 
kept in cotton batting with warm flannel 
wraps over it and hot-water bags and 
bottles surrounding it. We are told of 
infants who have been given up as dead, 
and abandoned in despair and left lying 



176 DEBILITY IN THE NEWLY-BORN. 

before a very hot fire; in a little while the 
extreme heat was found to have resusci- 
tated them, and they have lived and done 
well. 

Such feeble children should not be fa- 
tigued by bathing or by much handling- 
It is best to oil them, and then to wash 
them, if possible, in water of about 110° in 
temperature, or in whiskey, or whiskey 
and water, at the same degree of heat. If 
the debility is extreme, even this should 
not be attempted; the child should simply 
be wrapped in cotton batting and flannel. 
It will probably be too feeble to nurse, in 
which case some of the mother's milk can 
be drawn into a warm glass or teaspoon 
(by gently rubbing the breast toward the 
nipple) and dropped from the finger into 
its mouth. Or, as recommended by one 
authority, a teaspoonful of brandy or 
whiskey may be added to five teaspoonfuls 
of hot water slightly sweetened, and of 
this mixture the infant may be given a 
teaspoonful or two every few minutes, if 
absolutely necessary, or every quarter- 
hour, half-hour, or hour. It is claimed 



APPARENT ASPHYXIATION. 17? 

that the lives of several feeble children 
have been saved by this method. 

Occasionally infants are born apparent- 
ly dead who by patient and intelligent 
efforts can be revived. The first thing to 
be done is to make sure that there is nothing 
in the throat obstructing respiration. The 
nurse's little finger, covered with a clean, 
fine bit of linen or muslin, may be crooked 
and introduced into the mouth, and quickly 
swept around the throat, dislodging any 
mucus there. If this should not be suffi- 
cient to restore breathing, the treatment 
will differ according to whether the infant 
is in one of two conditions of asphyxia. 
In the first the face is red, or bluish, or 
mottled; the child lies motionless without 
breathing, while the heart may beat feebly 
or not at all; the eyeballs protrude and 
are bloodshot. In this case one of the best 
things to do is to untie the tape from the 
navel cord and allow a teaspoonf ul or two 
of blood to escape, then quickly and firmly 
tie it again. Sometimes this alone is suffi- 
cient to restore life. If not, plunge the baby 

into a bathtub of water at about 110° — and 
12 



178 APPARENT ASPHYXIATION. 

always use a thermometer to regulate heat, 
which must not be guessed at — keep it in 
for a half-minute, raise it to the surface 
of the water, and dash very cold water en 
the face and chest. If the attendant pre- 
fer not to bleed the child, and if she wish 
to do something to restore it even before 
the afterbirth has been delivered, the hot 
bath can be drawn to the side of the bed 
upon a chair and the baby immersed. It 
would be better to cut the cord, letting a 
little blood escape, tie it, and then practise 
the immersion. The baby may be plunged 
into hot and cold water several times alter- 
nately, ending with the hot water and 
immediately wrapping the child in flannels. 
Sometimes the attendant, by dropping a 
little brandy from a height upon the child's 
breast, may cause breathing movements. 
Another way is to hold the baby's nose 
and, placing the mouth against its lips, 
breathe into them, then release the nose 
and remove the mouth so that the air can 
come out again, which it will be aided in 
doing by pressure upon the child's sides at 
the same time. This may be repeated 



APPARENT ASPHYXIATION. 179 

every five seconds. A case is on record 
of a father who, in a hopeless fashion, 
breathed into his baby's lungs in this man- 
ner for an hour without any success, but 
was finally rewarded by slight efforts at 
breathing on the child's part, who presently 
breathed naturally and lived to become a 
strong, healthy man. 

Another method, known as the Sylves- 
ter method, is to lay the child on its back, 
with a little pillow or rolled towel under 
its head ; its arms are then slowly raised 
above its head and held there for five sec- 
onds, then pressed down firmly against 
the sides of the chest. This can be re- 
peated five or six times, after which the 
baby should be put in hot water to pre- 
vent chilling of the body. Then it may 
be taken out and the Sylvester method 
tried again. 

If the child is born apparently dead, but 
the skin, instead of being red and swollen, 
is extremely pale, the bleeding must not 
be practised. On the contrary, the infant 
should not be separated from the after- 
birth until the pulsations in the cord can 



180 INFLAMMATION OF THE EYES. 

no longer be felt. While still attached to 
the placenta it should be plunged into hot 
water, and then cold or iced water may be 
dashed upon the chest and face. If this 
cause the child to breathe or gasp, a little 
brandy or whiskey and water, in the pro 
portions given above, can be administered. 
If these means fail the cord should be cut 
and tied, and one of the methods of arti- 
ficial breathing tried, which must be pa- 
tiently and systematically persevered in. 

About three days after birth the nurse 
or attendant should carefully watch the 
baby's eyes for the first sign of inflam- 
matory trouble. If a little, thick secretion 
appears beneath the lids at the corners of 
the eyes, it should be gently washed off 
by a clean bit of fine linen, or, better yet, 
a new camers-hair brush dipped in borax 
and water (half a teaspoonf ul of powdered 
borax to a tumbler of water), after which 
a little sweet oil may be applied. Some- 
times this will be sufficient to remedy the 
trouble. When, however, the secretion 
persists and becomes thick and creamy, 
the lids being swollen and red, the most 



INFLAMMATION OF THE EYES. 181 

active measures must be taken or the 
baby may become blind. It has been 
estimated that 71.99 per cent of all per- 
sons who become blind during the first 
year of life become so from this disease, 
which is known as ophthalmia neona- 
torum, or ophthalmia of the newly-born ; 
and when one considers that the disease 
can usually ba prevented by cleanliness 
and care, pity for the sufferers is mingled 
with indignation at the ignorance or care- 
lessness which permits the calamity. 

It will be remembered that the direction 
was given to wipe the baby's eyes with a 
clean rag and wash them with a solution 
of borax in water as soon as it was born. 
This was with the view of preventing the 
disease of which we are now speaking, 
for if the discharges from the mother get 
into the baby's eyes they are, under some 
conditions, capable of occasioning the 
trouble. The danger is not over after 
birth, however, for carelessness in the use 
of towels or rags which have been used 
about the mother and become stained with 
the discharges has often been the cause of 



182 INFLAMMATION OF THE EYES. 

infection. It must not be inferred that all 
vaginal discharges have this power of in- 
fection ; it is only when certain diseased 
conditions exist that they possess it, but, 
as it is not always possible to tell whether 
these are present, the safest way is to fore- 
stall possible evil by prudent care. There- 
fore the most absolute cleanliness should 
be the rule in everything that is used 
about the infant. 

If, however, the disease have already 
attacked the eyes, unceasing vigilance 
will be required to combat the foe. Night 
and day the child will have to be cared 
for by physician and nurse to save it 
from blindness. The matter is too serious 
for home treatment ; moreover, there are 
certain delicate shades of difference in the 
conditions impossible of explanation to 
those inexperienced in diseases, and which 
require modifications of treatment. If 
only one eye is affected the other should 
be protected by a bandage of bichloride 
gauze, a little square of the gauze being 
placed directly against the eyelid. The 
disease is infectious, and the greatest care 



INFLAMMATION OF THE EYES. 183 

should be exercised to prevent the dis- 
charges from getting into the unaffected 
eye or into the eyes of any of the atten- 
dants. After washing and dressing the 
child's eyes the nurse's hands should be 
washed in an antiseptic solution made 
with creolin (five teaspoonfuls to the 
quart) or carbolic acid (two teaspoonfuls 
to the pint), or, under the physician's 
directions, of the bichloride of mercury. 



CHAPTEE XV. 

INFANT FEEDING — WEANING — DIET 
AFTER WEANING— BATHING. 

The feeding of infants is a subject of 
the utmost importance, and the one which 
causes the most perplexity to the in- 
experienced mother. We have already 
emphasized the fact that she should nurse 
her child herself, if she be in good health 
and have an abundant secretion of milk. 
Even if the amount be scanty it is better 
for her to give the child what there is, and 
supplement the diet with artificial food, 
than to resign nursing it altogether. Hu- 
man milk is the most perfect food for 
infants; it is, moreover, completely free 
from bacteria, and can therefore not be 
the source of infection to the child, which . 
unfortunately is not the case with cow's 
milk. 



INFANT FEEDING. 185 

Assuming that the mother nurses her 
own child, the manner and time of feed- 
ing are of importance. While at the 
breast it should devote itself to eating and 
not be allowed to doze and begin again. 
The breasts should be used alternately, 
one at each feeding, and after each meal 
the child's mouth should be washed out 
with a bit of linen dipped in tepid water. 
Twenty minutes will usually suffice for 
each meal. 

We have already stated that the child 
should be put to the breast as soon as 
possible after labor. It can be put there 
at intervals of two hours thereafter. 
During the first few days it will lose 
weight, because the fluid secreted then is 
insufficiently nourishing; little else will be 
needed, however, unless the baby is fret- 
ful, in which case a teaspoonful of warm 
milk and water may be occasionally ad- 
ministered. 

The following rules have been given for 
§ the feeding of infants, it being understood " 
that the child is fed less frequently at 
night than during the day: 



186 INFANT FEEDING. 

1st week, every2hrs.; 1 feedings in 24 hrs 

1st to 6th week, " 2J " 8 " " 

6th to 12th " " 3 " 6 " 

At 6 months, " 3 " 6 

At 10 " " 3 " 5 

If a child is nursed too often the water 
in the mother's milk becomes lessened in 
amount and the milk is too rich for the 
infant's digestion; while if the intervals 
between nursing are too long the milk be- 
comes thin and watery and is not suffi- 
ciently nourishing. 

Of course no iron-bound law can be laid 
down in regard to the intervals of feeding, 
because constitutions differ and the qual- 
ity of the milk also differs in different 
women, but the foregoing are excellent 
general rules for guidance. Sometimes 
the baby does not nurse properly and so 
does not secure all the food that it needs. 
But it is safe to say, as we have already 
said, that infants usually suffer from over- 
feeding rather than underfeeding, and 
that it is foolish to still every cry by put- 
ting the child at once to the breast. 

The nursing mother must strictly ob- 



INFANT FEEDING. 187 

serve the laws of health if she wish her 
child to thrive. She should lead a regu- 
lar, quiet life, free from excitement, 
should keep early hours, have plenty of 
fresh air and exercise, and be especially 
careful in her diet. The infant is exceed- 
ingly sensitive to changes in the mother's 
milk produced by indigestion, fasting, 
fatigue, mental emotion, fits of passion, 
bodily ailments, certain articles of food, 
medicines, etc. The mother should eat 
simple, nourishing food, avoiding spices 
and condiments and anything known to 
be indigestible. Coffee and tea may be 
taken in moderation, but it is a mistake to 
suppose that a large amount of beer will 
increase the flow of milk. Milk itself is 
the best food for that purpose and should 
be taken regularly and in large amount. 
Strong purgatives are to be avoided. 

If the physician decide that in the in- 
terest of the child the mother would better 
not nurse it, the secretion of milk should 
be stopped by means of compression 
exerted by the bandage previously de- 
scribed. Belladonna ointment should first 



188 WET-NURSE. 

be rubbed over the whole breast, and 
cotton batting distributed smoothly and 
evenly around the breasts, filling up the 
hollows, so that pressure may be equalized. 
The bandage is now put on very tightly 
and left on for from seven to nine days. 
If pain is caused the pressure should 
rather be increased than diminished. 

The choice now must be made between 
a wet-nurse and artificial feeding. Un- 
der proper conditions the former is the bet- 
ter, but the conditions are hard to fulfil. 
People of moderate means can ill bear the 
expense, for wet-nurses realize their value 
and charge high for their services. Per- 
sons of large as well as those of small 
means find it hard to stand the exactions, 
whims, and caprices of the average wet- 
nurse, who can usually constitute herself 
absolute monarch of the household by 
threats of leaving. Moreover, a woman 
excellently qualified to nourish the child 
is not necessarily intelligent or properly 
educated in regard to the care of it in 
other particulars, and constant supervi- 
sion is needed in order to insure that the 



ARTIFICIAL FOODS. 189 

rules of health are observed. The physi- 
cian should always be the one to choose a 
wet-nurse; there are certain qualifications 
necessary in the way of physical health 
which he must ascertain, and certain in- 
vestigations to be made as to the nurse's 
habits, disposition, the age of her own 
child, etc. , etc. 

Of all artificial foods, cow's milk is, 
on the whole, the best. It requires modi- 
fication before feeding it to an infant, for 
it is less sweet than human milk, is richer 
in certain substances, has an acid instead 
of an alkaline reaction, and forms thicker 
and tougher curds in the stomach. The 
greatest care must be exercised to secure 
the best milk obtainable. It should be 
fresh, of good quality, and be taken from 
perfectly healthy cows. It used to be sup- 
posed that the best results were obtained 
by having the milk from one cow only, but 
this the best authorities now consider to 
be an error. Cow's milk is by no means 
always the same in its composition, as it 
depends largely upon the quality of the food 
which the animal obtains, certain herbs 



190 ARTIFICIAL FOODS. 

altering its taste and sometimes its consti- 
tution. Moreover, during the different 
periods in the milking the milk varies in 
quality, and the child usually does not 
receive a mixture of the whole, but only one 
portion ; when, on the contrary, it nurses, 
it as a rule exhausts the whole supply of 
one breast and thus receives both the 
richer and the poorer quality. If the 
" one cow " upon whose milk the baby is 
fed happens to be diseased there is no 
escape for the infant, whereas when milk 
is taken from several cows there will be a 
less amount from any particular one, and 
the chances of freedom from taint are 
better. The milk now obtainable in cities 
is usually excellent in quality ; we refer, 
of course, to that sold by reputable dairies. 
In small grocery stores in crowded dis- 
tricts the milk is often allowed to stand 
for hours in a large can, the cover of 
which often remains off. As a conse- 
quence the milk absorbs odors and im- 
purities from the air, is unfit for the 
stomach of the strongest adult, and a 
hundredfold more unfit for the delicate 



ARTIFICIAL FOODS. 191 

stomach of an infant. It is always best, 
when possible, to procure the bottled milk. 
Women in the country are apt to con- 
gratulate themselves that the milk they 
obtain is above all suspicion ; so it may be, 
so it ought to be — so in numberless cases it 
is not. Who cannot recall a milk room in 
some farm house whose open window is 
directly above an open wooden trough 
through which flows the slop water from 
the kitchen, or which is near enough to 
a privy to receive and absorb foulness 
sufficient to cause many an infantile indi- 
gestion and diarrhoea ? To rid milk of all 
forms of impurity and bacteria it is neces- 
sary to boil, or rather to sterilize, it. Un- 
fortunately this process is apt to render it 
more difficult of digestion, and some in- 
fants who do not thrive upon milk scien- 
tifically prepared will have to imbibe it in 
a raw state, but always modified by the 
admixture of other ingredients, as will be 
described below. The following direc- 
tions have been given for preparing in- 
fants' food. As soon as the milk and 
cream come in the morning, mix as follows: 



192 ARTIFICIAL FOODS. 

Cream ounces 1£ 

Milk ounce 1 

Water ounces 5 

Milk sugar drachms 3| 

(A measuring glass, with the drachms 
and ounces plainly marked, may be ob- 
tained at a druggist's. Otherwise the 
measures may be thus estimated : 

Cream 12 teaspoonfuls or 3 tablespoonfuls 

Milk 8 " "2 

Water 10 tablespoonfuls 

Milk sugar.. . 3^ teaspoonfuls 

but it is far better .to obtain an accurate 
measuring glass.) This mixture is then 
heated. A sterilizing apparatus may be 
purchased by those who can afford it, and 
one with a perforated cover should be 
chosen If this cannot be obtained an 
ordinary kitchen double steamer may be 
used. A bottle containing the milk mix- 
ture, which has been poured in through a 
funnel and its neck plugged with cotton, 
is placed in the upper portion, while the 
lower is filled with water, and the whole 
placed over a gas or alcohol flame or on 
the stove. After the water begins to boil 



ARTIFICIAL FOODS. 103 

the bottle should remain over it for 
twenty minutes, then be removed and the 
mixture allowed to partially cool, after 
which half an ounce (four teaspoonfuls) 
of lime water is added, the cotton re- 
placed, and the bottle kept on ice. Lime 
water may be bought at the druggist's, 
but a simple way to prepare it is to pro- 
cure a piece of lime about the size of an 
English walnut, add two quarts of pure 
water, and let it stand for twenty-four 
hours. 

The mixture in the bottle represents the 
amount of food to be given during the 
twenty- four hours, and the nursing bottle 
should be filled from it. 

Should this process of sterilization de- 
mand more time than is at the mother's 
command, let her simply boil the mixture 
just before feeding. 

The estimated cost of the food thus pre- 
pared is twelve cents a day. The amount 
of the mixture to be given at each feeding 
depends upon the age of the infant. In a 
table given by a reliable authority it is 
estimated that in the first week one ounce 

13 



194 FEEDING BOTTLES. 

is taken at each feeding, with an ave- 
rage amount of ten ounces in the twenty- 
four hours. 

One to six weeks, l£-2 oz.; 12-16 oz. in 24 hrs. 
Six to twelve weeks, 3-4 " 18-24 " "24 " 
Six months, 6 "36 " " 24 " 

Ten " 8 " 40 " " 24 " 

This is the estimated amount for breast 
milk, but the rule holds good for this mix- 
ture, which has been made as nearly as 
possible to resemble human milk. 

Feeding bottles for infants should be 
used in preference to a spoon or a cup. A 
bottle should be chosen which has a rub- 
ber nipple fastened directly to the top and 
not connected by a tube. It is almost im- 
possible to keep the tube clean, and more- 
over the temptation is great to leave it 
near the child, who is allowed to suck 
or not as he feels inclined, even after the 
supply of milk is exhausted. This prac- 
tice is extremely harmful. The bottle 
should be held to the infant's mouth, and 
suckled, as are the breasts, for fifteen or 
twenty minutes, then be at once removed, 
washed in boiling water, kept in water in 



PATENT FOODS. 195 

which is borax or else boracic acid, two 
teaspoonfuls to the pint. Just before fill- 
ing for another feeding it should be rinsed 
with boiling water. 

Condensed milk is a favorite with 
many persons, because it is cheap and 
easily prepared. It is, however, scarcely 
nourishing enough to be depended upon 
for a steady diet, and although a child 
brought up on condensed milk may grow 
rapidly and be fat and apparently in good 
condition, it will probably not be as hardy 
and vigorous as desirable. However, if 
the choice be between poor cow's milk and 
condensed milk, preference should be 
given to the latter. Frequently, also, in 
travelling it may be used because of its 
convenience. It should be diluted with 
water in the proportion of one teaspoon- 
ful of milk to one ounce (eight teaspoon- 
fuls) of water, and if the child is over a 
month old a teaspoonful of cream should 
be added. 

Patent foods are occasionally useful 
as an addition to a milk diet, but they all 
contain more or less starch, and as the in- 



196 WEANING. 

fantfs digestive system is not fully able to 
cope with starch until it is ten or twelve 
months old, it can easily be seen that these 
foods would better be avoided. Yet, as in 
the case of condensed milk, some children 
seem to flourish upon their use ; these are, 
however, exceptional, and are probably of 
hardy constitution to start with. Milk 
can usually be depended upon for a per- 
fect food until the child is weaned . 

The weaning of the infant is the next 
point to be considered, and for this again 
no definite law can be laid down. Be- 
tween the ninth and the fourteenth month 
is the rule usually given, and a year is about 
the average. A variety of causes may 
necessitate weaning at an earlier date. 
The mother's milk may become scanty or 
of poor quality, as evidenced by deteriora- 
tion of the child's health ; the mother may 
also become ill and unable to nurse. The 
appearance of menstruation is considered 
by many persons to be the signal for wean- 
ing ; and while it is true that this may be 
required, it should not be hastily done. 
The condition of both child and mother 



WEANING. 197 

should be carefully watched, and if neither 
seems to suffer, and the baby appears to 
digest its food properly and to be well 
nourished, the mother may continue to 
nurse it. Sometimes the menses appear 
once, and then disappear again for several 
months ; it would be a pity to deprive the 
infant of breast milk in such a case, where- 
fore let nothing be done in haste. 

Pregnancy, however, as a usual thing, 
will necessitate weaning. Some women 
nurse their children for two or two and 
a half years, believing that they cannot 
become pregnant during lactation. This, 
however, is a great mistake, and often re- 
sults in the suffering of three people — the 
mother, who has to bear the strain and ex- 
haustion of nursing one child and carrying 
a second ; the first child, who is fed upon 
milk deficient in quality ; and the second 
child, who is carried by an exhausted 
mother when it has every right to expect 
an heritage of the utmost strength which 
can be given to it, and intra-uterine nour- 
ishment of the best quality. Weaning 
should, if possible, be a gradual process. 



198 WEANING. 

It should also not occur during teething 
nor during very hot or very cold weather. 
The eight incisor teeth usually appear at 
the twelfth month, which may be taken 
as an indication that the child is ready 
for something stronger than milk, which 
should, however, continue to be the chief 
feature of its diet for many months to 
come. At first a little bread and milk 
may be given instead of one of the regular 
breast nursings, or a little hominy, oat- 
meal, or mush in milk. Veal, mutton, 
and chicken broths may be added later, 
and beef tea which should contain bread or 
rice, because in itself it is not nourishing. 

The following dietary has been given for 
a baby which has been weaned after it 
has the eight incisor teeth and before the 
eight molars appear : 

"First meal, 6 a.m.: A cup of milk 
with cream biscuit, or a slice of buttered 
bread. 

"Second meal, 8 a.m.: Stale bread 
broken and soaked in a tumblerful of rich 
milk. 

" Third meal, 13 m. : A slice of buttered 



WEANING. 199 

bread with about half a pint of weak beef 
tea or mutton or chicken broth. 

"Fourth meal, 4 p.m. : A tumblerful of 
milk with crackers or a slice of buttered 
bread. 

"Fifth meal, 8 p.m.: A tumblerful of 
milk with bread or crackers." 

The child should not be wakened from 
sleep to be fed, and if it be hungry before 
the accustomed time it should be given its 
food. When the sixteen teeth have de- 
veloped, the following is substituted : 

"First meal, 6 a.m. : Bread or crackers 
with half a pint of milk 

"Second meal, 8 a.m.: A tablespoonful 
of oatmeal, cracked wheat, or cornmeal 
mush with milk and a couple of slices of 
buttered bread. 

" Third meal, 12 m. : Bread and butter, 
milk, and a soft-boiled egg. 

c< Fourth meal, -4 p.m.: A piece of rare 
roast beef to suck, mashed boiled potatoes 
moistened with dish gravy, bread and 
milk, and a small portion of bread jelly or 
farina. 

"Fifth meal, 8 p.m.: Milk and bread 



200 baby's bath. 

and crackers ; or give the fourth meal at 
3 p.m. and the fifth at 6 p.m., so that the 
child may be put to bed by 7 o'clock/' 

An infant should not be taken in the 
open air until the fourth or fifth week in 
summer, and about the sixth or eighth 
week in winter. It should be kept at 
home on very windy or damp days, and 
should always be sufficiently and warmly 
clad. At home it is well to let it wear 
short dresses, even in early infancy, in 
order that it may have a chance to kick 
its feet about and so develop the muscles 
of the legs. Creeping is an excellent ex- 
ercise, but the floor must be free from 
draughts of cold air. 

The baby's bath should be given daily 
with the regularity of clockwork; nothing 
so promotes the necessary activity of the 
skin. The water should be warm in early 
infancy, and as summer approaches it can 
be gradually and almost imperceptibly 
cooled, until finally a cold bath can be 
taken and enjoyed. This cold bath will 
do more to prevent the taking of colds than 



baby's bath. 201 

almost any other measure that can be de- 
vised, besides laying the foundation for a 
habit conducive to health and vigor. If, 
after a time, and in spite of rapid friction 
of the skin with hands and towel after the 
bath, it is seen that the child shivers, is 
pale and blue about the lips instead of 
being in a healthful glow, the cold bath 
must be stopped and the body be sponged 
with cold water, drying each portion be- 
fore the next is washed. Should this not 
have the desired effect, warm water will 
have to be used. The brisk and thorough 
drying is an important part of the bath — a 
soft towel may first be used, and then the 
hands ; if skilfully managed the child will 
enjoy it, and even, when old enough, join 
in it with his own hands, which will add to 
the benefit to be derived by joining active 
to passive exercise. 

Some one once made the remark that 
" many children were washed out of the 
world," and the phrase caught the popular 
fancy, especially of the indolent and not 
over-neat, and has been the justification 
of much neglect in this particular. The 



202 baby's bath. 

daily bath is a necessity to perfect health ; 
and even were it not, the marked difference 
in attractiveness to sight and smell be- 
tween children who are carefully treated 
in this respect and those who are not, 
would render it desirable. An unbathed 
child has a peculiarly musty odor, percep- 
tible to all who approach it, with the ex- 
ception perhaps of those who are always 
with it, whereas it is the privilege and 
right of babyhood to be as fresh as a rose 
and as sweet. "Bathe the baby every 
day ! " exclaimed a father in one of the 
New York tenements — " why! that would 
kill it ! " And the same horrified parent 
fed the child daily upon beer instead of 
milk ! 

The question of disease in infancy is 
foreign to this work. The chief object has 
been to prepare the young wife for the 
occurrences and emergencies of pregnancy 
and labor, and to give a few simple direc- 
tions for the care of her child during the 
early months of its life. 



INDEX. 

Abdomen, 4 

increase in size of, 14 
Abscess of breast, 161 
Afterbirth, delivery of, 149 
Age of mother as affecting labor, 25 
Albumin in urine, 21 
Anaemia, 59 

pernicious, and effect of pregnancy upon, 
101 
Antiseptic pads, 122 
Articles to be provided for infant, 125 
to be provided for mother, 124 
to be provided for physician, 129 
Asphyxiation, apparent, of infant 177 
treatment of, 177 

Sylvester's method in treatment of, 
179 

Bacteria, 57 

Bag of waters, function of, 134 

Bandage for breasts, 157 

of leg for varicose veins, 62 
Bath, baby's first, 165 

baby's daily, 200 
Bathing during pregnancy, 34 
Bed for confinement, 116 

feather, objections to, 116 

preparation of, 116 



204 INDEX 

Binder, 151 

Bladder, care of, after labor, 155 

disorders of, during pregnancy, 70 
Blood, circulation of, during pregnancy, 59 
Bowels, care of, after labor, 155 
Breast, abscess of, 161 

bandage for, 157 

care of, duriHg pregnancy, 40 

care of, after labor, 155 

changes in, 13 

placing of child to, 156 

pump, 42 
Breathing, difficulty in, 69 
Bright 's disease, effect of, upon pregnancy, 99 

Cancer of uterus, effect of pregnancy upon, 

100 
Care of infant, 1 65 

of mother after labor, 150 
Caul, 134 

Childbirth dangers lessened, 85 
Cleanliness, importance of, in preparations for labor, 
118 
after labor, 153 
Clothing for infant, 126 

of woman during labor, 118 
of woman during pregnancy, 38 
tight, 39 
Constipation, 46 

causes of, 48 
remedies for, 50 
Consumption, effect of pregnancy upon, 99 
Convulsions from kidney disease, 76 
Cord, bleeding of, 168 
dressing of, 167 
tying of, 147 
Corsets, 38 
Creolin as an antiseptic, 123 



INDEX. 205 

Date of confinement, 16 

Debility in newly-born infants, 175, 176 

Development of fetus, 9 

Diarrhoea, 53 

Diet after labor, 1 54 

during pregnancy, 32 

fruit or vegetable, 34 

for child after weaning, 198 
Douches, internal, 36 
Discharges, 80, 111, 114, 181, 153 
Diseases, influence of, upon pregnancy, 97 
which forbid pregnancy. 97. 99 
Drainage of house, 27 
Dry labor, 135 



Epilepsy, liability to be inherited, 99 
Erysipelas, effect upon pregnancy, 102 
Examination of pregnant woman, 20 

after labor, 163 
Exercise, 29 
Eyes, care of infant's, at birth, 148 

inflammation of, in infants, 180 



Fainting attacks, 68 
Feeding of infant, 184 

after weaning, 198 

amount of food to be taken, 194 

artificial foods, 189 

bottles, 194 

patent foods, 195 

^reparation of food, 191 
Fevers, eruptive, influence of, upon pregnant wo- 
man, 101 

non-eruptive, 102 

puerperal, 120 
Friends, visits after confinement, 152 



206 INDEX. 

Garters, 40 

Gums, inflammation of, 55 

Haemorrhoids, 65 

Heartburn, 46 

Heart disease, effect of pregnancy upon, 100 

Heating of house, 27 

Infant, apparent asphyxiation of, 177 

bath, first, 105 

bathing, 200 

care of, at birth, 148 

clothes of, 126 

debility of newly-born, 173, 175 

diet after weaning, 198 

examination of, after birth, 169 

inflammation of eyes of, 180 

meconium, 170 

open air, 200 

sleep, 171 

still-born, 173 

urine, 171 

weaning of, 196 
Insanity effect of pregnancy upon, 99 
Itching of body, 94 

of genitals, 77 

Jaundice during pregnancy, 105 

Kidneys, disease of, 72 

treatment of disease of, 75 

Labor, conduct of first stage, 137 
dry, 135 

duration of first stage, 135 
posture in, 141 



INDEX. 20? 



Labor, premature, 107 

preparations for, 115 

process of, 133 

second stage of, 140 

stages of, 131 

symptoms of approach of, 131 

third stage of, 149 
Laxatives, 53 
Leucorrhcea, 80 
" Life," or quickening, 15 
Lochia, 153 
Longings, 23 
Lying-in, duration of, 162 

Malarial fever during pregnancy, 103 

Mark of pregnancy, 93 

Measles, effect of, upon pregnancy, 102 

Meconium, 170 

Menses, absence of, 12 

Midwives, 22 

Milk, cow's, 189 

one cow's. 189 

method of stopping secretion of, 187 

preparation of cow's, 192 

secretion of, 187 

sterilization of, 191 
Miscarriage, 107 

causes of, 109 
dangers of, 108 
prevention of, 112 
Morning sickness, 13 

Nausea and vomiting, 43 

treatment of, 44 
Nervous disorders, effect of pregnancy upon, 
98 
system, disorders of, 82 



208 INDEX. 

Neuralgia, abdominal, 91 

facial, 89 
Nipples, cracked or tender, 158 
Nipple shield, 159 
Nurse, choice of, 22 

wet-, 188 
Nursing of child by mother, 160, 184 

causes which prevent, 160 

manner of, 185 

rules for, 1 86 



Ophthalmia neonatorum, 181 
Ovaries, 7 



Pain, abdominal, 91 
in back, 91 
in legs, 91 
Pains, meaning of term during labor, 136 
Palpitation of heart, 67 
Pelvis, deformities of, 100 
Period, monthly, absence of, 12 
Peristalsis, 48 

Perspiration, amount passed daily, 73 
Piles, 65 

Placenta or afterbirth, 8 
Pneumonia during pregnancy, 104 
Pregnancy, diseases forbidding, 97, 99 

duration of, 17 

essentials of health in, 24 

symptoms of, 12 

symptoms of, perceptible to physician, 
16 
Prenatal influences, 18 
Preparations for confinement, 115 
Pruritus, 94 
Purgatives, 53 



INDEX. 209 

Quickening, 15 

Rheumatism of uterus, 103 

Room, choice and preparation of, for confinement, 
115 



Saliva, increased amount, 54 
Scarlet fever, effect of, upon pregnancy, 102 
Self control, 31 
Septicaemia, 120 

Sex of child, determination of, 17 
Skin, diseases of, 93 
Sleep, 38 
Sleeplessness. 86 

Sm^l-pox, effect of, upon pregnancy, 101 
Superstitions about pregnancy, 22 
Swelling of feet and legs, 60 

Sylvester's method in treatment of apparent as- 
phyxiation of infant, 179 

Teeth, care of, 55 
Thorax, 4 
Toothache, 88 

Typhoid and typhus fevers during pregnancy, 
103 

Urine, albumin in, 21 

baby's, delay in passing, 171 

examination of , 21, 72 

incontinence of, 70 

retention of, 71 
Uterus and appendage, 5 

development of, during pregnancy, 132 

Varicose veins, 61 

veins of genital region, 64 
14 



210 INDEX. 

Ventilation of house, 26 
Vomiting, 43 

Wart-like growths, 80 
Weaning of infant, 196 
Wet-nurse, 188 
Whites, see Leucorrhoea 


















*bV 






O N ■ 









^% 






J*" > 
















*bF 






< ; V 



> ^ 










(\ X<? Si 






• 4 ^ 

. ^SW^. o ^ 








?,• y% '••^• : /% .^. 




iT 




